The Diagnostic Accuracy of Contrast-Enhanced Ultrasound in Distinguishing Between Benign and Malignant Ovarian Cancers: A Quantitative Structured Literature Review

Abstract

Abstract Background: Ovarian cancer (OC) continues to be a major challenge in women's health due to non-specific symptoms and late diagnosis, making early detection methods crucial. While conventional ultrasound (US) is accessible and affordable, it is limited by operator dependency and in characterising complex adnexal masses. Contrast-enhanced ultrasound (CEUS) presents a real-time, non-ionising alternative that could improve OC diagnostic accuracy by better visualising vascular dynamics and tumour characteristics. Aim & Objectives: This review update aimed to assess the diagnostic accuracy of CEUS in adult women, focusing on research from the past decade. It had three specific objectives: (1) to provide an updated quantitative analysis of CEUS’s accuracy in distinguishing benign from malignant OC, correlated with histopathology; (2) to update the meta-analyses by Qiao et al. (2015) and Wu et al. (2015) with recent studies, reflecting the latest advancements in CEUS; and (3) to address the limitations of previous reviews and existing studies on CEUS accuracy in OC. Methodology: A structured literature review (SLR) was conducted using the PIO framework. Comprehensive searches across multiple electronic databases were performed to identify relevant cohort-selection cross-sectional diagnostic test accuracy (DTA) studies that met predefined inclusion and exclusion criteria. The methodological quality of the included studies was appraised using the QUADAS-2 checklist. Results: Four studies met the inclusion criteria and were subject to analysis. All studies demonstrated that CEUS has high diagnostic accuracy, with sensitivity ranging from 89.6% to 96.97% and specificity from 86.84% to 97.2%. These findings are consistent with previous reviews. Positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were also assessed, with ranges of 92.1% to 93.2%, 91.67% to 95.6%, and 92% to 95.83%, respectively, indicating the high reliability of CEUS. The methodological quality assessment of the included studies revealed high external validity but identified potential biases in at least one domain for each study due to unclear information. Conclusions: This SLR update confirms CEUS as a highly accurate diagnostic tool for distinguishing between benign and malignant ovarian masses, consistent with earlier meta-analyses. Despite methodological limitations, this update strengthens the evidence for CEUS’s clinical relevance, underscoring the need for standardised protocols and further research.