Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Gastrointest Endosc. 2019 Aug;90(2):196-203.e1. doi: 10.1016/j.gie.2019.04.217. Epub 2019 Apr 17.
BACKGROUND AND AIMS: EUS and magnetic resonance imaging (MRI) are both used for locoregional staging of rectal cancer, which determines treatment options. There is a lack of consensus on the best modality for locoregional staging, with studies supporting both EUS and MRI. In this study, we performed the first diagnostic test accuracy meta-analysis to compare the diagnostic accuracy, sensitivity, and specificity of EUS and MRI in the staging of rectal cancer. METHODS: A comprehensive electronic literature search up to June 2018 was performed to identify prospective cohort studies directly comparing the accuracy of EUS with MRI in staging nonmetastatic rectal cancer with surgical pathology as the reference standard. Quality of the included studies was measured by using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A bivariate hierarchical model was used to perform the meta-analysis of diagnostic test accuracy according to the Cochrane approved methodology. Summary receiver operating characteristics were developed, and the area under the curve was calculated for overall and individual T and N staging, for EUS, MRI, and head-to-head comparison. RESULTS: Six of 2475 studies including 234 patients were eligible. Pooled sensitivity and specificity in T staging were .79 (95% confidence interval [CI], .72-.85) and .89 (95% CI, .84-.93) for EUS and .79 (95% CI, .72-.85) and .85 (95% CI, .79-.90) for MRI, respectively. Pooled sensitivity and specificity in N staging were .81 (95% CI, .71-.89) and .88 (95% CI, .80-.94) for EUS and .83 (95% CI, .73-.90), and .90 (95% CI, .82-.95) for MRI, respectively. In area under the curve head-to-head analysis, EUS was superior to MRI in overall T staging (P < .05). EUS outperformed MRI in overall T, overall N, T1, and T3 staging (P < .01), after excluding studies using an endorectal coil for MRI. MRI was superior to EUS in T2 staging (P = .01) in both analyses. CONCLUSIONS: EUS and MRI both provide reasonable diagnostic accuracy in the staging of nonmetastatic rectal cancer. EUS was superior to MRI in overall T staging and overall T and N staging after adjusting for MRI technology. Practitioners should be aware of advantages and disadvantages of both modalities and choose appropriate methods while considering diagnostic accuracy of each test and institutional practices and limitations.
背景与目的：超声内镜（EUS）和磁共振成像（MRI）均用于直肠癌的局部区域分期，这决定了治疗方案。对于哪种方式是局部区域分期的最佳方式，目前尚无共识，研究结果对 EUS 和 MRI 均有支持。本研究首次进行了诊断试验准确性的荟萃分析，以比较 EUS 和 MRI 在直肠癌分期中的诊断准确性、敏感度和特异度。
方法：我们进行了全面的电子文献检索，检索截至 2018 年 6 月，以确定直接比较 EUS 和 MRI 在以手术病理为参考标准的非转移性直肠癌分期中准确性的前瞻性队列研究。使用 QUADAS-2 工具来测量纳入研究的质量。根据 Cochrane 认可的方法，使用双变量分层模型进行诊断试验准确性的荟萃分析。制定了综合受试者工作特征曲线，并计算了 EUS、MRI 和头对头比较的总 T 分期、总 N 分期、T 分期和 N 分期的曲线下面积。
结果：2475 项研究中有 6 项，共纳入 234 例患者符合纳入标准。EUS 的 T 分期的汇总敏感度和特异度分别为 0.79（95%置信区间[CI]，0.72-0.85）和 0.89（95% CI，0.84-0.93），MRI 的分别为 0.79（95% CI，0.72-0.85）和 0.85（95% CI，0.79-0.90）。EUS 的 N 分期的汇总敏感度和特异度分别为 0.81（95% CI，0.71-0.89）和 0.88（95% CI，0.80-0.94），MRI 的分别为 0.83（95% CI，0.73-0.90）和 0.90（95% CI，0.82-0.95）。在曲线下面积的头对头分析中，EUS 在总体 T 分期方面优于 MRI（P<.05）。在排除使用直肠内线圈进行 MRI 的研究后，EUS 在总体 T 分期、总体 N 分期、T1 分期和 T3 分期方面均优于 MRI（P<.01），而 MRI 在 T2 分期方面优于 EUS（P=.01），在两种分析中均如此。
结论：EUS 和 MRI 在非转移性直肠癌的分期中均具有合理的诊断准确性。在调整 MRI 技术后，EUS 在总体 T 分期和总体 T 和 N 分期方面优于 MRI。临床医生应了解两种方式的优缺点，并在考虑每种检查的诊断准确性以及机构的实践和局限性的基础上选择合适的方法。
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