Objectives To evaluate the diagnostic performance of image-guided puncture in differentiating malignant from benign peritoneal lesions. Materials and methods An independent literature search was conducted across multiple English medical databases, including PubMed, Embase, Web of Science, Cochrane Library and Ovid. The diagnostic accuracy of image-guided puncture was compared against postoperative pathology and diagnostic laparoscopy, which served as reference standards. The diagnostic performance of imaging-guided puncture was evaluated by calculating pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve (AUC). Subgroup analyses were conducted based on imaging modality, type of puncture, and the risk assessment derived from the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results Fifteen eligible studies, comprising a total sample of 1208 patients with 1165 peritoneal lesions, were included in the analysis. The pooled sensitivity of image-guided puncture for differentiating malignant from benign peritoneal lesions was 93% (95% confidence intervals (CI): 91–95%), with a specificity of 95% (95% CI: 92–97%), a DOR of 149.02 (95% CI: 78.47–282.99), and an AUC of 0.97. Conclusion Overall, this meta-analysis demonstrates that image-guided puncture is a minimally invasive and safe technique with high diagnostic accuracy, regardless of the imaging modality, puncture method, or lesion type (mass or diffuse infiltration). It offers a reliable alternative to invasive biopsy for diagnosing peritoneal lesions. Subgroup analysis revealed no significant differences in diagnostic efficacy across the evaluated parameters. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> The diagnosis of peritoneal lesions remains challenging due to the inherent complexity and invasiveness of traditional diagnostic laparoscopy, as well as overlapping imaging features of routine imaging examinations. <Emphasis Type="BoldItalic">Findings</Emphasis> Image-guided puncture is a minimally invasive and safe technique with high diagnostic accuracy, irrespective of the imaging modality used, the puncture method, or the type of peritoneal lesion. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Image-guided puncture is recognized as a safe, minimally invasive, and highly sensitive diagnostic tool, which can reduce patient discomfort compared to diagnostic laparoscopy. In most clinical scenarios, it represents a reliable and effective alternative to this invasive procedure. Graphical Abstract

Image-guided puncture for differentiating malignant from benign peritoneal lesions: a systematic review and meta-analysis

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2025年11月20日

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Yi-Lin Hou,
Jia-Yue Sun,
Xue-Mei Wang,
Zhi-Guang Chen,
Xi-Yu Zhang,
Cheng-Fei Sun,
Di Wu,
Yun-Fei Zhang

摘要

Objectives

To evaluate the diagnostic performance of image-guided puncture in differentiating malignant from benign peritoneal lesions.

Materials and methods

An independent literature search was conducted across multiple English medical databases, including PubMed, Embase, Web of Science, Cochrane Library and Ovid. The diagnostic accuracy of image-guided puncture was compared against postoperative pathology and diagnostic laparoscopy, which served as reference standards. The diagnostic performance of imaging-guided puncture was evaluated by calculating pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve (AUC). Subgroup analyses were conducted based on imaging modality, type of puncture, and the risk assessment derived from the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

Results

Fifteen eligible studies, comprising a total sample of 1208 patients with 1165 peritoneal lesions, were included in the analysis. The pooled sensitivity of image-guided puncture for differentiating malignant from benign peritoneal lesions was 93% (95% confidence intervals (CI): 91–95%), with a specificity of 95% (95% CI: 92–97%), a DOR of 149.02 (95% CI: 78.47–282.99), and an AUC of 0.97.

Conclusion

Overall, this meta-analysis demonstrates that image-guided puncture is a minimally invasive and safe technique with high diagnostic accuracy, regardless of the imaging modality, puncture method, or lesion type (mass or diffuse infiltration). It offers a reliable alternative to invasive biopsy for diagnosing peritoneal lesions. Subgroup analysis revealed no significant differences in diagnostic efficacy across the evaluated parameters.

Key Points

Question The diagnosis of peritoneal lesions remains challenging due to the inherent complexity and invasiveness of traditional diagnostic laparoscopy, as well as overlapping imaging features of routine imaging examinations.

Findings Image-guided puncture is a minimally invasive and safe technique with high diagnostic accuracy, irrespective of the imaging modality used, the puncture method, or the type of peritoneal lesion.

Clinical relevance Image-guided puncture is recognized as a safe, minimally invasive, and highly sensitive diagnostic tool, which can reduce patient discomfort compared to diagnostic laparoscopy. In most clinical scenarios, it represents a reliable and effective alternative to this invasive procedure.

Graphical Abstract