Systematic review and meta-analysis of growth rates of small XXXX .

@entity1 @entity439 @entity1028
BACKGROUND: Small @entity1028 are usually asymptomatic and managed safely in ultrasound surveillance programmes until they grow to a diameter threshold where intervention is considered. The aim of this study was to synthesize systematically the published data on growth rates for small @entity439 to investigate the evidence basis for surveillance intervals. METHODS: This was a systematic review of the literature published before January 2010, which identified 61 potentially eligible reports. Detailed review yielded 15 studies providing growth rates for @entity439 3  0-5  5 cm in diameter (14 in millimetres per year, 1 as percentage change per year). These studies included 7630 @entity1 (predominantly @entity1 ) enrolled during 1976-2005. RESULTS: The pooled mean growth rate was 2  32 (95 per cent confidence interval 1  95 to 2  70) mm/year but there was very high heterogeneity between studies; the growth rate ranged from - 0  33 to + 3  95 mm/year. Six studies reported growth rates by 5-mm diameter bands, which showed the trend for growth rate to increase with @entity439 diameter. Simple methods to determine growth rate were associated with higher estimates. Meta-regression analysis showed that a 10-mm increase in @entity439 diameter was associated with a mean(s.e.m.) 1  62(0  20) mm/year increase in growth rate. Neither mean age nor percentage of @entity1 in each study had a significant effect. On average, a 3  5-cm @entity439 would take 6  2 years to reach 5  5 cm, whereas a 4  5-cm @entity439 would take only 2  3 years. CONCLUSION: There was considerable variation in the reported growth rates of small @entity439 beyond that explained by @entity439 diameter. Fuller evidence on which to base surveillance intervals for @entity1 in screening programmes requires a meta-analysis based on individual @entity1 data.
