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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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201395%), with a specificity of 95% (95% CI: 92\u201397%), a DOR of 149.02 (95% CI: 78.47\u2013282.99), and an AUC of 0.97.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12026-w","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T16:23:26Z","timestamp":1763655806000},"page":"3903-3915","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Image-guided puncture for differentiating malignant from benign peritoneal lesions: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"36","author":[{"given":"Yi-Lin","family":"Hou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Yue","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue-Mei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-Guang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi-Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng-Fei","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9064-3314","authenticated-orcid":false,"given":"Yun-Fei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"12026_CR1","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/path.4942","volume":"243","author":"A Capobianco","year":"2017","unstructured":"Capobianco A, Cottone L, Monno A, Manfredi AA, Rovere-Querini P (2017) The peritoneum: healing, immunity, and diseases. 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