Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China.
Department of Gastroenterology, Jing Men No.2 People's Hospital, Jingchu Center Hospital Affiliated to Institute of Technology, Jing Men City, 448000, Hubei, China.
Surg Endosc. 2017 Dec;31(12):4923-4933. doi: 10.1007/s00464-017-5596-8. Epub 2017 May 25.
To conduct a meta-analysis to provide accurate evidence regarding the preferred diagnostic method, magnifying endoscopy (ME) or endoscopic ultrasonography (EUS), for assessment of the depth of invasion of the gastrointestinal neoplasms.
PubMed, EMBASE, Ovid Medline, and the Cochrane Library databases were searched for studies published between January 1946 and October 2016, regarding the use of EUS and ME to assess the invasion depth of gastrointestinal cancers. The quality of diagnostic studies was evaluated using the QUADAS2 instrument. The Meta-DiSc software (version 1.4) was used for meta-analysis of the pooled data regarding the diagnostic accuracy of EUS and ME of the invasion depth of gastrointestinal neoplasms.
Our meta-analysis included the data of 754 patients with gastrointestinal cancers contributed by seven prospective studies. All studies were of high quality (QUADAS2). The receiver operating characteristic (ROC) planes were not observed in shoulder and arm forms for either EUS or ME, with Spearman's correlation coefficients of -0.821 and 0.234 for EUS and ME, respectively. The p values of the diagnostic odds ratio for EUS and ME were 0.0038 and 0.0131, respectively. The sensitivity and specificity of EUS for the diagnosis of the depth of invasion of gastrointestinal cancers were 0.75 (95% CI 0.69-0.81) and 0.84 (95% CI 0.79-0.88), respectively. In comparison, the sensitivity and specificity for ME were 0.74 (95% CI 0.67-0.69) and 0.85 (95% CI 0.80-0.89), respectively. The values of area under the summary ROC (SROC) curves for EUS and ME were 0.8499 and 0.8757, respectively, with a non-significant Z value between EUS and MR (0.296 < 1.96).
Both EUS and ME provide a comparable performance for judging the depth of invasion of gastrointestinal neoplasms. However, there is heterogeneity between studies contributed by non-threshold effects.
进行荟萃分析，为评估胃肠道肿瘤的浸润深度提供更准确的证据，以确定哪种诊断方法（放大内镜 ME 或内镜超声检查 EUS）更具优势。
检索 1946 年 1 月至 2016 年 10 月间发表的有关 EUS 和 ME 用于评估胃肠道癌症浸润深度的研究，使用 QUADAS2 工具评估诊断研究的质量。使用 Meta-DiSc 软件（版本 1.4）对 EUS 和 ME 评估胃肠道肿瘤浸润深度的诊断准确性的汇总数据进行荟萃分析。
本荟萃分析纳入了 7 项前瞻性研究的 754 例胃肠道癌患者的数据。所有研究均为高质量研究（QUADAS2）。EUS 和 ME 的 ROC 曲线均未呈现肩臂形态，Spearman 相关系数分别为-0.821 和 0.234。EUS 和 ME 的诊断比值比的 p 值分别为 0.0038 和 0.0131。EUS 诊断胃肠道癌症浸润深度的敏感性和特异性分别为 0.75（95%CI 0.69-0.81）和 0.84（95%CI 0.79-0.88）。相比之下，ME 的敏感性和特异性分别为 0.74（95%CI 0.67-0.69）和 0.85（95%CI 0.80-0.89）。EUS 和 ME 的汇总 SROC 曲线下面积（SROC）分别为 0.8499 和 0.8757，EUS 和 ME 之间的 Z 值无统计学意义（0.296<1.96）。
EUS 和 ME 对判断胃肠道肿瘤的浸润深度具有相当的性能。然而，由于存在非阈值效应，各研究间存在异质性。
