title: Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review.
abstract: BACKGROUND
  Vascular invasion (VI) in a patient with pancreatic or periampullary cancers precludes surgery and indicates a poor prognosis. Published data on the accuracy of EUS in diagnosing VI is varied.
  
  
  OBJECTIVE
  The aim of this meta-analysis was to evaluate the accuracy of EUS in diagnosing VI in patients with pancreatic and periampullary cancers.
  
  
  METHODS
  Data from EUS studies were pooled according to the Mantel-Haenszel and DerSimonian Laird methods.
  
  
  METHODS
  EUS studies in which VI was confirmed by surgery or angiography were selected.
  
  
  METHODS
  EUS.
  
  
  METHODS
  Pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of EUS.
  
  
  RESULTS
  Data were extracted from 29 studies (N = 1308) that met the inclusion criteria. The pooled sensitivity of EUS in diagnosing VI was 73% (95% CI, 68.8-76.9) and the pooled specificity was 90.2% (95% CI, 87.9-92.2). The positive likelihood ratio for diagnosing VI by EUS was 9.1 (95% CI, 4.6-17.9) and the negative likelihood ratio was 0.3 (95% CI, 0.2-0.5). Diagnostic odds ratio, the odds of having VI in positive as compared with negative EUS studies, was 40.1 (95% CI, 16.1-99.9). The P value for chi(2) heterogeneity for all the pooled estimates was >.05.
  
  
  CONCLUSIONS
  Although EUS is the best noninvasive test to diagnose VI in pancreatic and periampullary cancers, this meta-analysis showed that the specificity (90%) is high but the sensitivity (73%) is not as high as suggested. Further refinements in EUS technologies and interpretation may improve the sensitivity for detecting VI.
authors.affiliation: Division of General and Geriatric Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.forename: Shailender
authors.initials: S
authors.lastname: Singh
authors.forename: Curt H
authors.initials: CH
authors.lastname: Hagedorn
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Reddy
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Olyaee
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D014670:Ampulla of Vater; D044963:Biopsy, Fine-Needle; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D019160:Endosonography / Q000379:methods; D006801:Humans; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019043:Vascular Neoplasms