Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: A meta-analysis

Background and Aim: Endoscopic ultrasound (EUS) elastography is not used for detection but rather for characterization of solid pancreatic masses. A meta-analysis was used to assess the accuracy of EUS elastography for identification of malignant pancreatic masses. Methods: PubMed, the Cochrane Library, and the ISI Web of Knowledge were searched. The studies relating to evaluation accuracy of qualitative or quantitative EUS elastography for identification of malignant pancreatic masses were collected. Language was limited to English. The sensitivity and specificity were used to examine the accuracy. Clinical utility was evaluated by likelihood ratio scattergram. Results: A total of 10 studies including 893 pancreatic masses (646 malignant, 72.3%) were analyzed. The summary sensitivity and specificity for the diagnosis of malignant pancreatic masses were 0.98 (95% confidence interval [CI] 0.93-1.00) and 0.69 (95% CI 0.52-0.82) for qualitative EUS elastography, and 0.96 (95% CI 0.86-0.99) and 0.76 (95% CI 0.58-0.87) for quantitative EUS elastography, respectively. The hierarchical summary receiver operating characteristic curves were 0.94 and 0.93 for qualitative and quantitative EUS elastography. The accuracy of quantitative methods was similar to qualitative methods. The positive and negative likelihood ratios were 3.15 and 0.03 for qualitative EUS elastography, and 3.94 and 0.05 for quantitative EUS elastography, respectively. Both qualitative and quantitative methods were useful for exclusion of presence of malignant pancreatic masses and not for its confirmation. Conclusions: EUS elastography could be used as a good identification tool for benign and malignant pancreatic masses, with its good performance for exclusion of presence of malignant pancreatic masses.