Abstract：
OBJECTIVE: Contrast-enhanced ultrasound (CEUS) has been increasingly used for the diagnostic identification of neoplasms due to its ability to visualize the microvascularization of lesions. In the study of testicular abnormalities, the appropriate use of CEUS can improve the diagnostic accuracy of conventional gray-scale ultrasound and color Doppler ultrasound (CDUS). The purpose of this study is to comprehensively evaluate the diagnostic performance of CEUS in testicular space-occupying lesions.
METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from the inception of each database to November 16, 2022 for relevant studies. The required data were extracted, and the methodological quality of the studies was assessed using the QUADAS-2 tool. The diagnostic value of CEUS was assessed by calculating the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, and a summary receiver operating characteristic (SROC) curve was used to conduct this meta-analysis.
RESULTS: A total of six studies with 354 testicular space-occupying lesions were included in the analysis. The results showed that CEUS could provide additional useful information for the diagnosis of testicular space-occupying lesions, with a sensitivity of 0.92 (95% CI:0.82, 0.97), specificity of 0.91 (95% CI:0.80, 0.96), diagnostic odds ratio of 114 (95% CI:25, 528), respectively, and an overall diagnostic accuracy expressed as area under the SROC curve (AUC) of 0.97 (95% CI:0.95-0.98). Significant heterogeneity was seen in the sensitivity with I2 = 82.53% (95% CI:69.44-95.61). Subgroup analysis revealed that the proportion of infertile patients selected may be the source of heterogeneity.
CONCLUSIONS: CEUS can be used to diagnose testicular space-occupying lesions more accurately and improve diagnostic accuracy when the conventional US cannot accurately differentiate the type of lesion. In particular, CEUS should be recommended for the identification of microscopic lesions so that physicians can provide patients with more appropriate interventions to avoid unnecessary orchiectomy.
METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from the inception of each database to November 16, 2022 for relevant studies. The required data were extracted, and the methodological quality of the studies was assessed using the QUADAS-2 tool. The diagnostic value of CEUS was assessed by calculating the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, and a summary receiver operating characteristic (SROC) curve was used to conduct this meta-analysis.
RESULTS: A total of six studies with 354 testicular space-occupying lesions were included in the analysis. The results showed that CEUS could provide additional useful information for the diagnosis of testicular space-occupying lesions, with a sensitivity of 0.92 (95% CI:0.82, 0.97), specificity of 0.91 (95% CI:0.80, 0.96), diagnostic odds ratio of 114 (95% CI:25, 528), respectively, and an overall diagnostic accuracy expressed as area under the SROC curve (AUC) of 0.97 (95% CI:0.95-0.98). Significant heterogeneity was seen in the sensitivity with I2 = 82.53% (95% CI:69.44-95.61). Subgroup analysis revealed that the proportion of infertile patients selected may be the source of heterogeneity.
CONCLUSIONS: CEUS can be used to diagnose testicular space-occupying lesions more accurately and improve diagnostic accuracy when the conventional US cannot accurately differentiate the type of lesion. In particular, CEUS should be recommended for the identification of microscopic lesions so that physicians can provide patients with more appropriate interventions to avoid unnecessary orchiectomy.
摘要：
目的：由于超声造影（CEUS）具有可视化病变微血管形成的能力，因此越来越多地用于肿瘤的诊断鉴定。在睾丸异常的研究中，适当使用CEUS可以提高常规灰阶超声和彩色多普勒超声(CDUS)的诊断准确率。目的综合评价CEUS在睾丸占位性病变中的诊断表现。
方法：对PubMed的全面搜索，Embase,科克伦图书馆,和WebofScience数据库从每个数据库开始到2022年11月16日进行相关研究。提取了所需的数据，使用QUADAS-2工具评估研究的方法学质量.通过计算联合灵敏度评估CEUS的诊断价值，特异性，正似然比，负似然比，和诊断赔率比，并使用汇总受试者工作特征(SROC)曲线进行荟萃分析.
结果：共有6项研究包括354例睾丸占位性病变。结果表明，CEUS可以为睾丸占位性病变的诊断提供额外的有用信息，灵敏度为0.92（95%CI：0.82，0.97），特异性为0.91（95%CI：0.80，0.96），诊断比值比为114（95%CI：25,528），分别,以SROC曲线下面积（AUC）表示的总体诊断准确性为0.97（95％CI：0.95-0.98）。敏感性存在显著异质性，I2=82.53%（95%CI：69.44-95.61）。亚组分析显示，选择的不育患者比例可能是异质性的来源。
结论：当常规超声不能准确区分病变类型时，CEUS可以更准确地诊断睾丸占位性病变，提高诊断准确性。特别是,应建议使用CEUS来识别微观病变，以便医生可以为患者提供更适当的干预措施，以避免不必要的睾丸切除术。
方法：对PubMed的全面搜索，Embase,科克伦图书馆,和WebofScience数据库从每个数据库开始到2022年11月16日进行相关研究。提取了所需的数据，使用QUADAS-2工具评估研究的方法学质量.通过计算联合灵敏度评估CEUS的诊断价值，特异性，正似然比，负似然比，和诊断赔率比，并使用汇总受试者工作特征(SROC)曲线进行荟萃分析.
结果：共有6项研究包括354例睾丸占位性病变。结果表明，CEUS可以为睾丸占位性病变的诊断提供额外的有用信息，灵敏度为0.92（95%CI：0.82，0.97），特异性为0.91（95%CI：0.80，0.96），诊断比值比为114（95%CI：25,528），分别,以SROC曲线下面积（AUC）表示的总体诊断准确性为0.97（95％CI：0.95-0.98）。敏感性存在显著异质性，I2=82.53%（95%CI：69.44-95.61）。亚组分析显示，选择的不育患者比例可能是异质性的来源。
结论：当常规超声不能准确区分病变类型时，CEUS可以更准确地诊断睾丸占位性病变，提高诊断准确性。特别是,应建议使用CEUS来识别微观病变，以便医生可以为患者提供更适当的干预措施，以避免不必要的睾丸切除术。
