From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.).
Radiology. 2021 Jun;299(3):583-594. doi: 10.1148/radiol.2021202857. Epub 2021 Mar 30.
Background Although CT, endoscopic US, and PET are critical in determining the appropriate management of esophageal carcinoma (squamous cell carcinoma and adenocarcinoma), previous reports show that staging accuracy remains low, particularly for nodal involvement sensitivity. Purpose To perform a systematic review and meta-analysis to determine the diagnostic performance of MRI for multiple staging thresholds in patients with biopsy-proven esophageal carcinoma (differentiation of stage T0 disease from stage T1 or higher disease, differentiation of stage T2 or lower disease from stage T3 or higher disease, and differentiation of stage N0 disease from stage N1 or higher disease [where T refers to tumor stage and N refers to nodal stage]). Materials and Methods Studies of the diagnostic performance of MRI in determining the stage of esophageal carcinoma in patients before esophagectomy and pathologic staging between 2000 and 2019 were searched in PubMed, Scopus, Web of Science, and Cochrane Library by a librarian and radiation oncologist. Pooled diagnostic performance of MRI was calculated with a bivariate random effects model. Bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (version 2) tool. Results Twenty studies with a total of 984 patients were included in the analysis. Pooled accuracy for stage T0 versus stage T1 or higher had a sensitivity of 92% (95% CI: 82, 96) and a specificity of 67% (95% CI: 51, 81). Pooled accuracy for stage T2 or lower versus stage T3 or higher had a sensitivity of 86% (95% CI: 76, 92) and a specificity of 86% (95% CI: 75, 93). Pooled accuracy for stage N0 versus stage N1 or higher had a sensitivity of 71% (95% CI: 60, 80) and a specificity of 72% (95% CI: 64, 79). The concern for applicability was low for the patient selection, index test, and reference test domains, except for 10% of studies (two of 20) that had unclear concern for patient selection applicability. Conclusion MRI has high sensitivity but low specificity for the detection of esophageal carcinoma, which shows promise for determining neoadjuvant therapy response and for detecting locally advanced disease for potential trimodality therapy. © RSNA, 2021 See also the editorial by Leeflang in this issue.
背景 尽管 CT、内镜超声和 PET 在确定食管癌（鳞状细胞癌和腺癌）的适当治疗方法方面至关重要，但先前的报告表明，分期准确性仍然较低，特别是对于淋巴结受累的敏感性。目的 进行系统评价和荟萃分析，以确定 MRI 在经活检证实的食管癌（区分 T0 期疾病与 T1 期或更高期疾病、区分 T2 期或更低期疾病与 T3 期或更高期疾病、以及区分 N0 期疾病与 N1 期或更高期疾病[其中 T 指肿瘤分期，N 指淋巴结分期]）多个分期阈值中的诊断性能。材料与方法 由一名图书管理员和放射肿瘤学家在 PubMed、Scopus、Web of Science 和 Cochrane Library 中搜索了 2000 年至 2019 年间关于 MRI 在食管癌患者术前和病理分期中确定分期的诊断性能的研究。使用双变量随机效应模型计算 MRI 的汇总诊断性能。使用诊断准确性研究质量评估（第 2 版）工具评估偏倚。结果 共有 20 项研究，共纳入 984 例患者，纳入分析。T0 期与 T1 期或更高期相比，T0 期的汇总准确率为 92%（95%CI：82,96），特异性为 67%（95%CI：51,81）。T2 期或更低期与 T3 期或更高期相比，T2 期或更低期的汇总准确率为 86%（95%CI：76,92），特异性为 86%（95%CI：75,93）。N0 期与 N1 期或更高期相比，N0 期的汇总准确率为 71%（95%CI：60,80），特异性为 72%（95%CI：64,79）。在患者选择、索引测试和参考测试方面，除了 10%（20 项研究中有两项）的研究对患者选择适用性存在不确定的情况外，适用性的关注程度较低。结论 MRI 对食管癌的检测具有较高的敏感性，但特异性较低，这为确定新辅助治疗反应和检测潜在的三联疗法局部晚期疾病提供了希望。 ©2021 RSNA，见本期社论
