de Jong Ellen A, ten Berge Josianne C E M, Dwarkasing Roy S, Rijkers Anton P, van Eijck Casper H J
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Surgery. 2016 Mar;159(3):688-99. doi: 10.1016/j.surg.2015.10.019. Epub 2015 Nov 24.
To perform a metaanalysis to determine and compare the diagnostic performance of MRI, endorectal ultrasonography (ERUS), and computed tomography (CT) in predicting the response of locally advanced rectal cancer after preoperative therapy.
All previously published articles on the role of MRI, CT, and/or ERUS in predicting the response of rectal cancer to preoperative therapy were collected. We divided the objective in 3 parts: the accuracy to assess (i) complete response, (ii) to detect T4 tumors with invasion to the circumferential resection margin (CRM), and (iii) to predict the presence of lymph node metastasis. The pooled estimates of, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated using a bivariate mixed effect analysis.
Forty-six studies comprising 2,224 patients were included. (i) The pooled accuracy to assess complete tumor response were (a) 75% for MRI, (b) 82% for ERUS, (c) and 83% for CT. (ii) Pooled accuracy to detect T4 tumors with invasion to the CRM were (a) 88% and (b) 94% for ERUS. (iii) Pooled accuracy to predict the presence of lymph node metastasis was (a) 72% for MRI, (b) 72% for ERUS, (c) and 65% for CT.
MRI, CT, and ERUS cannot be used to predict complete response of locally advanced rectal cancer after CRT. In addition, the positive predictive value for these imaging techniques is low for the assessment of tumor invasion in the CRM. The accuracy of the modalities to predict the presence of metastatic lymph node disease is also low.
进行一项荟萃分析，以确定并比较磁共振成像（MRI）、直肠内超声检查（ERUS）和计算机断层扫描（CT）在预测局部晚期直肠癌术前治疗反应方面的诊断性能。
收集所有先前发表的关于MRI、CT和/或ERUS在预测直肠癌术前治疗反应中作用的文章。我们将目标分为三个部分：评估（i）完全缓解、（ii）检测侵犯环周切缘（CRM）的T4肿瘤以及（iii）预测淋巴结转移存在情况的准确性。使用双变量混合效应分析计算敏感性、特异性、阳性预测值、阴性预测值和准确性的合并估计值。
纳入了46项研究，共2224例患者。（i）评估肿瘤完全缓解的合并准确性分别为：（a）MRI为75%，（b）ERUS为82%，（c）CT为83%。（ii）检测侵犯CRM的T4肿瘤的合并准确性分别为：（a）ERUS为88%，（b）ERUS为94%。（iii）预测淋巴结转移存在情况的合并准确性分别为：（a）MRI为72%，（b）ERUS为72%，（c）CT为65%。
MRI、CT和ERUS不能用于预测局部晚期直肠癌在接受放化疗后的完全缓解情况。此外，这些成像技术在评估CRM处肿瘤侵犯时的阳性预测值较低。这些检查方法预测转移性淋巴结疾病存在情况的准确性也较低。
