Diagnostic value of ASVS for insulinoma localization: A systematic review and meta-analysis

BACKGROUND: Previous studies on the diagnostic value of arterial calcium stimulation with hepatic venous sampling (ASVS) for the localization of insulinoma have reported inconsistent results. Here, we performed a meta-analysis of the relevant published studies. METHODS: PubMed, Embase, Web of Science, the Cochrane Library, and Wanfang Data were searched for studies on the diagnostic value of ASVS in insulinoma localization published up to May 2019. We calculated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curve of ASVS in the localization of insulinoma. RESULTS: We included ten studies involving 337 patients in the study. The pooled sensitivity, specificity, PLR, and NLR were 0.93 (95% confidence interval [CI]: 0.83–0.97), 0.86 (95%CI: 0.75–0.93), 6.8(95%CI: 3.7–12.7), and 0.08 (95%CI: 0.03–0.19), respectively. The DOR was 84 (95%CI: 30–233), and the area under the ROC curve was 0.96 (95%CI: 0.94–0.97).The results of the heterogeneity of the studies (P = 0.00, I(2) = 80.17) were calculated using forest plots of the DOR. CONCLUSION: ASVS is of significant value in localization of insulinoma. If a qualitative diagnosis of insulinoma is definite and the imaging examination results are negative, ASVS should be performed to confirm the localization of insulinoma.