Sonoelastography for Testicular Tumor Identification: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy
Abstract
:Simple Summary
Abstract
1. Introduction
- How well can sonoelastography distinguish a testicular neoplasm from a non-neoplasm (i.e., identify a tumor)?
- How well can sonoelastography classify benign and malignant tumors?
- What are the sonoelastographic determinants for the identification/classification? And how could they be obtained?
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Information Source
2.3. Search Strategy
2.4. Study Selection Process
2.5. Data Collection and Extraction
2.6. Methodological Quality Assessment
2.7. Meta-Analysis
3. Results
3.1. Search and Study Selection Results
3.2. Qualitative Synthesis
3.2.1. Population
3.2.2. Index Test
3.2.3. Reference Test
3.2.4. Outcome Measures and Classification
3.2.5. Study Quality (Risk of Bias and Applicability)
3.3. Quantitative Synthesis
Meta-Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Article | Sample Size | Mean Age | Sampling | Patient Source | Referral Indications |
---|---|---|---|---|---|
Aigner et al. [47] (2012) | 50 PP/PT | 42 (18–81) | Retrospective, consecutive | - | Patients with clinical suspicion of testicular tumor |
Auer et al. [48] (2017) | 55 PP/PT | 39.5 (SD: 14.9) | Retrospective, consecutive | Radiology department | Evaluations of scrotal pain, scrotal abnormality, varicoceles, infertility, sexual development disorder, and F/U indetermined scrotal ultrasound findings. |
Corcioni et al. [49] (2022) | * 78 PP/81 PT | 34.3 (SD:12.2)+ 35.8 (SD:12.2)− | Prospective, consecutive | University hospital | Infertility, andrological screening, testicular pain |
Goddi et al. [50] (2012) | 88 PT | # 34 (2 months–89 years) | Consecutive | Medical Center | Scrotal abnormalities |
Konstantatou et al. [51] (2019) | 86 PP/PT | Median: 36 (16–81) | Retrospective, consecutive | Hospital | Acute and nonacute scrotal conditions, indetermined focal intratesticular abnormality |
Pozza et al. [52] (2016) | 106 PP | 34.5 (28–41.2) | Prospective, consecutive | Inpatients and outpatients referred to University | Infertility, andrological screening, F/U contralateral or ipsilateral tumor, testicular pain, varicocele, Klinefelter’s syndrome, F/U microlithiasis, elevated level of alpha-fetoprotein |
Reginelli et al. [53] (2019) | 54 PP/PT | Median: 42.2 (10–64) | Retrospective, consecutive | - | Clinical suspicion of testicular mass |
Rocher et al. [54] (2019) | 86 PP 89 PT | 37.9 (SD: 13.2) | Prospective, consecutive | - | Infertility, pain, abnormal self-palpation, and others |
Roy et al. [55] (2020) | ! 338 PP 606 PT | 43.2 (SD: 17.2, 17–78) | Prospective, consecutive | Ultrasound department | - |
Schröder et al. [56] (2016) | 67 PP 68 PT | Median: 39.8 (18–83) | Prospective, Consecutive | - | Suspicious testicular mass |
Shaaban [57] (2017) | 21 PP 23 PT | 30 (18–54) | - | - | - |
Non-Neoplastic (Non-Tumor) | Neoplastic (Tumor) | |
---|---|---|
Benignity | Malignancy | |
|
|
|
Article | Index Test (Instrument) | Measurements and Features | ||
---|---|---|---|---|
Elastography | Other B-Mode US/Doppler | Comparison | ||
Aigner et al. [47] | SE: HI Vision EUB 8500 | Sequoia 512 | B vs. Doppler vs. SE |
|
Auer et al. [48] | SE: HI Vision Ascendus | Logic E9 | Doppler vs. CEUS vs. SE vs. (Doppler + SE) vs. (CEUS + SE) |
|
Corcioni et al. [49] | SE: Aplio 500 | Esaote MyLab 70 Gold XVG | SE vs. CEUS |
|
Goddi et al. [50] | SE: HI Vision EUB 8500 | Preirus | B + SE + Doppler |
|
Konstantatou et al. [51] | SE: Hitachi HV900 | Siemens S2000 | B vs. Doppler vs. SE |
|
Pozza et al. [52] | SE: Philips IU22 | - | B vs. SE |
|
Reginelli et al. [53] | SE: Hi-Vision Preirus | - | SE vs. (B + Doppler) vs. (B + Doppler + SE) |
|
Rocher et al. [54] | SWE: Aixplorer | Aplio 500 | SWE vs. (B + Doppler) vs. (B + Doppler + SWE) |
|
Roy et al. [55] | SWE: Aplio 500 | - | SWE |
|
Schröder et al. [56] | SE: - | Philips iU-22 | SE vs. (B + Doppler) |
|
Shaaban [57] | SE: Hitachi Hi Vision Avius | - | B + Doppler + SE |
|
Article | Reference Test | No. of Radiologist (yr. exp) | Blind | |
---|---|---|---|---|
Test for (+) | Test for (−) | |||
Aigner et al. [47] | HPA | Benign: F/U in 6 weeks & 3 months. Inflammation: F/U after 2–3 days & then weekly Infarction: F/U within 24 h. | 1 (>5) | YES |
Auer et al. [48] | HPA | Sonographic F/U within the 1st 2–3 days, then weekly up to 6 week, & after 3 months | 2 (>10 in SE) | YES |
Corcioni et al. [49] | HPA, patients declined HPA underwent F/U at least 2 years. | 1 (>10) | - | |
Goddi et al. [50] | HPA | F/U every 3 or 6 months | 3 (>20 in US) | - |
Konstantatou et al. [51] | HPA | F/U until resolution or non-progression was documented | 2 (6 & 7 in SE) | YES |
Pozza et al. [52] | Biomarkers (human chorionic gonadotropin, placental alkaline phosphatase, alpha-fetoprotein, carcinoembryonic antigen, ferritin, lactate dehydrogenase) | 2 (>5) | YES | |
HPA, patients declined HPA underwent F/U every 3 months for a min of 18 months | Repeated F/U (6 consecutive scans) | |||
Reginelli et al. [53] | Biomarkers (alpha-fetoprotein, beta-human chorionic gonadotropin) | 1 (15) | - | |
Nodules > = 2 cm: HPA. Nodules < 2 cm with malignant pattern: Inguinoscrotal exploration | F/U over time | |||
Rocher et al. [54] | HPA | Clinical tests (17-hydroxyprogesterone, C-reactive protein, leukocytes) | 1 (>20 in US) | - |
Roy et al. [55] | History, clinical tests, B-mode and Doppler ultrasound, recovery after antibiotic treatment, abscesses confirmed surgically, no modification of ultrasound on F/U > 1 year | 2 (6 & 20) | - | |
Schröder et al. [56] | HPA | 1 (-) | - | |
Shaaban [57] | HPA | F/U up to one month | 1 (8 in SE) | - |
Article | Classification | Modality | Evaluation Metrics and Outcomes | ||||||
---|---|---|---|---|---|---|---|---|---|
Acc | Sn/Rc | Sp | PPV/Pc | NPV | AUC | Others | |||
Aigner et al. [47] | Tumor vs. non-tumor | SE | 94% | 100% | 81% | 92% | 100% | - | - |
B | 92% | 100% | 75% | 89% | 100% | - | - | ||
Auer et al. [48] | Malignant vs. benign | SE | 78.2% | 100% | 72.1% | - | - | - | - |
Doppler | 83.6% | 66.7% | 88.4% | - | - | - | - | ||
CEUS | 81.8% | 100% | 76.7% | - | - | - | - | ||
SE + Doppler | 89.1% | 66.7% | 95.3% | - | - | - | - | ||
SE + CEUS | 94.5% | 100% | 93.0% | - | - | - | - | ||
Corcioni et al. [49] | Malignant vs. benign | SE | - | 66.7% | - | - | - | - | - |
LCT vs. non-LCT | - | 36.0% | - | - | - | - | - | ||
LCT vs. non-LCT | CEUS | - | 96.9% | 94.0% | - | - | 0.954 | DOR: 480.5 | |
Goddi et al. [50] | Malignant vs. benign | SE: VES | 95.8% | 87.5% | 98.2% | 93.3% | 96.4% | - | - |
Konstantatou et al. [51] | Malignant vs. benign | Doppler | - | 77.4% | 81.8% | - | - | - | - |
SE: SR | - | 74.2% | 70.9% | - | - | 0.722 | - | ||
SE: VES | 58.1% | 80.7% | 45.5% | 45.5% | 80.7% | 0.620 | - | ||
Neoplastic vs. non-neoplastic | Doppler | - | 68.8% | 97.4% | - | - | - | - | |
SE: SR | - | 68.8% | 81.6% | - | - | 0.730 | - | ||
SE: VES | 70.9% | 81.3% | 57.9% | 70.9% | 71.0% | 0.715 | - | ||
Pozza et al. [52] | Malignant vs. benign | B | - | 89.2% | 85.5% | 76.7% | 93.7% | 0.878 | - |
SE: SR | - | 59.4% | 66.6% | 48.9% | 75.4% | 0.631 | - | ||
SE: VES | - | 81.1% | 79.7% | 68.2% | 88.7% | 0.804 | - | ||
Neoplastic vs. non-neoplastic | B | - | 94.6% | 87.1% | 94.7% | 87.1% | 0.910 | - | |
SE: SR | - | 69.3% | 61.3% | 81.2% | 45.2% | 0.653 | - | ||
SE: VES | - | 58.7% | 100% | 100% | 50% | 0.793 | - | ||
Reginelli et al. [53] | ! Malignant vs. benign | B + Doppler | 81.0% | 86.0% | 64.0% | 84.0% | 48.0% | - | - |
SE | 87.0% | 85.0% | 78.0% | 93.0% | 71.0% | - | - | ||
B + Doppler + SE | 90.0% | 100% | 83.0% | 91.0% | 100% | - | - | ||
Rocher et al. [54] | (Malignant + Burnout tumor) vs. benign LCT | B + Doppler: size | 77.9% | 67.3% | 96.4% | 97.1% | 62.8% | 0.88 | - |
SWE: SD | 79.8% | 93.9% | 62.5% | 75.4% | 89.3% | 0.77 | - | ||
B + Doppler + SWE: # | 86.5% | 95.9% | 75.0% | 82.5% | 93.8% | 0.93 | - | ||
* (Malignant + Burnout tumor) vs. (Benign LCT + other benign tumors) | B + Doppler: Calcification score | 74.2% | 55.1% | 97.5% | 96.4% | 63.9% | 0.85 | - | |
SWE: SD | 79.8% | 93.9% | 62.5% | 75.4% | 89.3% | 0.77 | - | ||
B + Doppler + SWE: # | 86.5% | 95.9% | 75.0% | 82.5% | 93.8% | 0.91 | - | ||
Roy et al. [55] | ! Tumor vs. non-tumor | SWE: ROI filling | - | 82% | 81% | 85% | 98% | 0.881 | - |
Schröder et al. [56] | Neoplastic vs. non-neoplastic | B | 88.2% | 100% | 42.9% | 87.1% | 100% | - | - |
Doppler | 82.1% | 81.1% | 85.7% | 95.6% | 54.5% | - | - | ||
SE: VES | 84.6% | 98.1% | 25.0% | 85.2% | 75.0% | - | - | ||
SE: ΔVES | 89.1% | 97.8% | 50.0% | 89.8% | 83.3% | - | - | ||
SE: SR | 81.1% | 90.5% | 45.5% | 86.4% | 55.6% | - | - | ||
B + SE: Q-size | 61.1% | 56.7% | 83.3% | 94.4% | 27.8% | - | - | ||
CEUS | 91.0% | 92.6% | 84.6% | 96.2% | 73.3% | - | - | ||
Shaaban [57] | ! Neoplastic vs. non-neoplastic | B + Doppler + SE | - | 100% | 40% | 37.5% | 100% | - | - |
Comparison | Subgroup Analysis | Pooled Sensitivity (95% CI) | Pooled Specificity (95% CI) | Pooled DOR (95% CI) |
---|---|---|---|---|
Non-neoplasm vs. Neoplasm | Summary | 92.1% (62.8% to 98.7%) | 79.2% (26.2% to 97.6%) | 44.21 (5.48 to 356.79) |
SE color code | - | - | - | |
SE scoring system | 84.4% (58.5% to 95.4%) | 72.1% (13.9% to 97.6%) | 14.01 (2.10 to 93.46) | |
SWE | - | - | - | |
Benignity vs. Malignancy | Summary | 86.0% (79.7% to 90.6%) | 82.4% (60.4% to 93.5%) | 28.71 (9.60 to 85.88) |
SE color code | 86.% (65.9% to 95.3%) | 82.2% (57.0% to 94.1%) | 26.77 (7.14 to 115.84) | |
SE scoring system | 83.2% (73.5% to 89.8%) | 84.6% (43.3% to 97.5%) | 27.22 (2.81 to 263.27) | |
SWE | - | - | - |
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Lai, D.K.-H.; Cheng, E.S.-W.; Mao, Y.-J.; Zheng, Y.; Yao, K.-Y.; Ni, M.; Zhang, Y.-Q.; Wong, D.W.-C.; Cheung, J.C.-W. Sonoelastography for Testicular Tumor Identification: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. Cancers 2023, 15, 3770. https://doi.org/10.3390/cancers15153770
Lai DK-H, Cheng ES-W, Mao Y-J, Zheng Y, Yao K-Y, Ni M, Zhang Y-Q, Wong DW-C, Cheung JC-W. Sonoelastography for Testicular Tumor Identification: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. Cancers. 2023; 15(15):3770. https://doi.org/10.3390/cancers15153770
Chicago/Turabian StyleLai, Derek Ka-Hei, Ethan Shiu-Wang Cheng, Ye-Jiao Mao, Yi Zheng, Ke-Yu Yao, Ming Ni, Ying-Qi Zhang, Duo Wai-Chi Wong, and James Chung-Wai Cheung. 2023. "Sonoelastography for Testicular Tumor Identification: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy" Cancers 15, no. 15: 3770. https://doi.org/10.3390/cancers15153770