Diagnostic Value Of Transvaginal Ultrasound Real-time Tissue Elastography For Cervical Cancer: A Meta-Analysis

Objective:Cervical cancer is one of the common malignant tumors in gynecology,and its incidence rate ranks the first place among the female reproductive system malignancies in our country.Because of its insidious onset and poor prognosis,early diagnosis is extremely important.Ultrasound elastography is a new ultrasonic diagnostic technique.The hardness change of the target tissue can be reflected by measuring the elastic coefficient of the tissue,and then the pathological condition can be evaluated.At present,there are many clinical studies on the diagnostic value of transvaginal elastography for cervical cancer.In order to further clarify the transvaginal ultrasound real-time tissue sonoelastography on the early diagnostic value of cervical cancer and to provide basis for clinical decision making,this topic systematically evaluates the diagnostic value by summarizing all relevant research data and using meta-analysis.Methods:The literatures concerning the diagnosis of cervical cancer by transvaginal ultrasound real-time ultrasound elastography were searched on database of PubMed,EMbase,CNKI,VIP and Wanfang,and the search time was from the establishment of the database to January 2018.Two postgraduate students majoring in ultrasound medicine independently screened the articles according to the established inclusion and exclusion criteria.The QUADAS quality assessment tool was used to evaluate the quality of the included literatures,and relevant data were extracted.Meta-analysis was performed using Stata 12.0 software to calculate the combined Sen,Spe,PLR,NLR,DOR and their 95%CI according to the corresponding effect model.Meanwhile,the SROC was plotted to obtain the AUC,and then regression analysis and subgroup analysis were used to explore the sources of heterogeneity,and funnel plot was drawn to detect publication bias of the included articles.Results:In the end,25 studies were included,including 21 in Chinese and4 in English,with a total of 2303 patients.We used the I~2 statistic as the evaluation index of heterogeneity,the I~2 values of Sen and Spe were both more than 50%,indicating that there was a large heterogeneity caused by the nonthreshold effect,and the results should be combined and analyzed by random effects model.Meta-analysis showed that transvaginal ultrasound real-time tissue sonoelastography for the diagnosis of cervical cancer with Sen,Spe,PLR,NLR,DOR was 0.85[95%CI(0.82,0.88)],0.88[95%CI(0.83,0.92)],7.4[95%CI(4.8,11.3)],0.17[95%CI(0.13,0.21)],44[95%CI(24,82)]respectively,and AUC is 0.92[95%CI(0.89,0.94)].Meta regression analysis and subgroup analysis were conducted on the included studies interms of research type,it included the age of the subjects,sample size and truncation value of elasticity score,and so on.The results suggested that the heterogeneity may be related to the different cut-off value of elasticity score.A bias analysis of the included studies were performed using a funnel plot,suggesting that there might be publication bias,but after excluded the marginal literature,the above results did not change significantly.Conclusions:Transvaginal ultrasound real-time ultrasound elastography has a good diagnostic value for cervical cancer,which can be used as a useful supplement to judge the benign and malignant cervical diseases.