Imaging modalities for inguinal hernia diagnosis: a systematic review
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REVIEW
Imaging modalities for inguinal hernia diagnosis: a systematic review E. Piga1 · D. Zetner1 · K. Andresen1 · J. Rosenberg1 Received: 25 February 2020 / Accepted: 6 April 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose The aim of the study was to determine which diagnostic modality [Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), or ultrasound (US)] is more precise in terms of sensitivity and specificity in diagnosing inguinal hernia and sub-type of inguinal hernia (direct or indirect). Methods This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA), and a search for relevant articles was undertaken in PubMed, Embase, and the Cochrane Library. Inclusion criteria were original studies that preoperatively diagnosed patients suspected of inguinal hernia by either CT, MRI, or US and compared diagnostic findings with operative findings or definitive follow-up. The main outcomes were the diagnostic certainty of inguinal hernia and type of hernia by sensitivity and specificity. All eligible studies were searched in the Retraction Watch database to ensure that all included studies were suitable for inclusion. Results Bubble charts depicting the size of each patient cohort and percentual range for both sensitivity and specificity showed that US was better than CT and MRI in diagnosing inguinal hernia. Bubble charts for US and CT depicted high values within the studies that reported sensitivity and specificity in diagnosing type of hernia. Conclusions We found that US had the highest sensitivity and specificity. However, it must be taken into consideration that performance is highly dependent on the operator’s level of expertise. Based on this systematic review, ultrasound may be the preferred imaging modality when physical examination is inconclusive, given that local expertise in performing US examination for hernia disease is adequate. Keywords Inguinal hernia · Diagnostic modalities · Sensitivity · Specificity · Systematic review
Introduction Inguinal hernia is one of the most common conditions in abdominal surgery and is a common cause of groin pain. On a global scale, over 20 million inguinal hernia operations are performed annually [1]. Inguinal hernias can be classified as an indirect or a direct inguinal hernia [2, 3], and indirect hernias are most common and are more often seen in the male population [3]. The resulting groin lump from an inguinal hernia is often clinically visible and palpable making diagnostic imaging unnecessary [3, 4]. This is in accordance with the European Hernia Society (EHS) who states that in most cases the diagnosis should be determined * E. Piga [email protected] 1
Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
by physical examination [5]. However, it is not always possible to make the diagnosis solely by physical examination. The herni
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