Diagnostic accuracy of cervical elastography in predicting preterm delivery A systematic review and meta-analysis

Abstract

Background: The aim of the study was to evaluate the diagnostic accuracy of cervical elastography in predicting preterm delivery (PTD). Methods: We searched the PubMed, EMBASE, and Cochrane databases to identify relevant studies that applied ultrasound (US) elastography to assess cervical stiffness and predict PTD. All the studies were published before December 11, 2018, and only studies published in English were collected. The cervical length (CL) was considered a comparator, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was performed to evaluate the diagnostic performance of cervical elastography in predicting PTD. Subgroup analyses were also performed. Results: Seven studies, including 1488 pregnant women, were included in this meta-analysis. Cervical elastography showed a summary sensitivity of 0.84 [95% confidence interval (CI): 0.68, 0.93], a specificity of 0.82 (95% CI: 0.63, 0.93), a diagnostic odds ratio of 25 (95% CI: 7, 93), and an area under the curve (AUC) of SROC of 0.90 (95% CI: 0.87-0.93). CL measurement showed that the AUC of SROC was 0.60 (95% CI: 0.56-0.64). The results of subgroup analysis showed that the summary sensitivity and specificity were different in the QUADAS-2 score subgroups. Conclusion: Cervical elastography is a promising and reliable method to predict PTD. Cervical elastography showed better diagnostic performance to predict PTD than CL measurement. Abbreviations: ARFI = acoustic radiation force impulse, AUC = area under the curve, CI = confidence interval, CL = cervical length, DOR = diagnostic odds ratio, FN = false negative, FP = false positive, LR = likelihood ratio, PTD = preterm delivery, QUADAS- 2 = Quality Assessment of Diagnostic Accuracy Studies-2, SE = strain elastography, SROC = summary receiver operating characteristic, SSI = supersonic shear imaging, SWE = shear wave elastography, SWS = shear wave speed, TDI = tissue Doppler imaging, TN = true negative, TP = true positive, US = ultrasound.