Diagnostic ability of intraoperative ultrasound for identifying tumor residual in glioma surgery operation

Achieving total glioma resection represents a major challenge to neurosurgeons with no distinct margin between tumor and surrounding brain tissue. Many imaging methods are employed in surgery visualization and resection control. We performed this meta-analysis to assess the diagnosis value of intraoperative ultrasound and judged whether ultrasound is a suitable tool in detecting glioma residual. The databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu were systematically searched to find out relevant studies and published up to May 5, 2017. A total of 14 studies involving 542 participants met the selection criteria and bivariate mixed effects models were used for analysis. The parameters and their corresponding 95% confidence interval (CI) were computed on Stata 12.0 software. The pooled sensitivity was 0.75 (95%CI: 0.62-0.84), specificity was 0.88 (95%CI: 0.79-0.94), positive likelihood ratios was 6.27 (95%CI: 3.76-10.47), negative likelihood ratios was 0.29 (95%CI: 0.20-0.42), diagnostic odds ratios was 21.83 (95%CI: 14.20-33.55) and area under the curve of summary receiver operator characteristic was 0.89. Stratified meta-analysis showed sensitivity and area under the curve in low-grade glioma were both higher than high-grade glioma. The Deek's plot showed no significant publication bias (t = -1.03, P = 0.33). Intraoperative ultrasound has high overall diagnostic value to identify glioma remnants, especially in low-grade glioma, which shows a benefit for prognosis and life quality of patients. In general, Intraoperative ultrasound is an effective tool for maximizing the extent of glioma resection.