title: Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review.
abstract: BACKGROUND
  Nodal staging in patients with rectal cancer predicts prognosis and directs therapy. Published data on the accuracy of endoscopic ultrasound (EUS) for diagnosing nodal invasion in patients with rectal cancer has been inconsistent.
  
  
  OBJECTIVE
  To evaluate the accuracy of EUS in diagnosing nodal metastasis of rectal cancers.
  
  
  METHODS
  Study Selection Criteria: Only EUS studies confirmed by surgical histology were selected. Data Collection and Extraction: Articles were searched in Medline, Pubmed, and CENTRAL.
  
  
  METHODS
  Pooling was conducted by both fixed-effects model and random-effects model.
  
  
  RESULTS
  The initial search identified 3610 reference articles in which 352 relevant articles were selected and reviewed. Data were extracted from 35 studies (N = 2732) that met the inclusion criteria. Pooled sensitivity of EUS in diagnosing nodal involvement by rectal cancers was 73.2% (95% confidence interval [95% CI] 70.6-75.6). EUS had a pooled specificity of 75.8% (95% CI 73.5-78.0). The positive likelihood ratio of EUS was 2.84 (95% CI 2.16-3.72), and negative likelihood ratio was 0.42 (95% CI 0.33-0.52). All the pooled estimates, calculated by fixed- and random-effect models, were similar. SROC curves showed an area under the curve of 0.79. The P for chi-squared heterogeneity for all the pooled accuracy estimates was >.10.
  
  
  CONCLUSIONS
  EUS is an important and accurate diagnostic tool for evaluating nodal metastasis of rectal cancers. This meta-analysis shows that the sensitivity and specificity of EUS is moderate. Further refinement in EUS technologies and diagnostic criteria are needed to improve the diagnostic accuracy.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MO, USA. srinivaspuli@yahoo.com
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
authors.forename: Jyotsna B K
authors.initials: JB
authors.lastname: Reddy
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
authors.forename: Abhishek
authors.initials: A
authors.lastname: Choudhary
authors.forename: Mainor R
authors.initials: MR
authors.lastname: Antillon
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
mesh_terms: D019160:Endosonography; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D012680:Sensitivity and Specificity