Puli Srinivas-R, Reddy Jyotsna-Bk, Bechtold Matthew-L, Antillon Daphne, Ibdah Jamal-A, Antillon Mainor-R
Division of Gastroenterology, M580a Health Science Center, One Hospital Drive, M580a, Columbia, Missouri 65212, United States.
World J Gastroenterol. 2008 Mar 14;14(10):1479-90. doi: 10.3748/wjg.14.1479.
To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer.
Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights.
Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the c2 test of heterogeneity for all pooled estimates was > 0.10.
EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.
评估内镜超声（EUS）在食管癌分期中的准确性。
仅选择经手术证实的EUS研究。在Medline和Pubmed中检索文章。两名审阅者独立检索并提取数据。通过计算敏感性、特异性、似然比和诊断比值比的合并估计值，对EUS的准确性进行Meta分析。采用Mantel-Haenszel法（固定效应模型）和DerSimonian Laird法（随机效应模型）进行合并。基于逆方差权重，使用Cochran's Q检验对研究的异质性进行检验。
本分析纳入了49项符合纳入标准的研究（n = 2558）。EUS诊断T1期的合并敏感性和特异性分别为81.6%（95%CI：77.8 - 84.9）和99.4%（95%CI：99.0 - 99.7）。诊断T4期时，EUS的合并敏感性为92.4%（95%CI：89.2 - 95.0），特异性为97.4%（95%CI：96.6 - 98.0）。采用细针穿刺抽吸（FNA）时，EUS诊断N分期的敏感性从84.7%（95%CI：82.9 - 86.4）提高到96.7%（95%CI：92.4 - 98.9）。所有合并估计值的异质性c2检验的P值> 0.10。
EUS在准确诊断食管癌TN分期方面具有出色的敏感性和特异性。EUS对晚期（T4）疾病的诊断效果优于早期（T1）疾病。FNA显著提高了EUS评估N分期疾病的敏感性和特异性。在食管癌分期时应强烈考虑使用EUS。
