Staging accuracy of esophageal cancer by endoscopic ultrasound: a meta-analysis and systematic review.
OBJECTIVE
To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer.


METHODS
Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights.


RESULTS
Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the c2 test of heterogeneity for all pooled estimates was > 0.10.


CONCLUSIONS
EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.
Puli
Srinivas-R
SR
Division of Gastroenterology, M580a Health Science Center, One Hospital Drive, M580a, Columbia, Missouri 65212, United States.
Reddy
Jyotsna-Bk
JB
Bechtold
Matthew-L
ML
Antillon
Daphne
D
Ibdah
Jamal-A
JA
Antillon
Mainor-R
MR
D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D009367:Neoplasm Staging / Q000379:methods*; D017594:Publication Bias; D012680:Sensitivity and Specificity