title: Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis.
abstract: BACKGROUND
  The prognosis of esophageal cancer (EC) depends on the depth of tumor invasion and lymph node metastasis. EC limited to the mucosa (T1a) can be treated effectively with minimally invasive endoscopic therapy, whereas submucosal (T1b) EC carries relatively high risk of lymph node metastasis and requires surgical resection.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of EUS in differentiating T1a EC from T1b EC.
  
  
  METHODS
  We performed a comprehensive search of MEDLINE, SCOPUS, Cochrane, and CINAHL Plus databases to identify studies in which results of EUS-based staging of EC were compared with the results of histopathology of EMR or surgically resected esophageal lesions. DerSimonian-Laird random-effects model was used to estimate the pooled sensitivity, specificity, and likelihood ratio, and a summary receiver operating characteristic (SROC) curve was created.
  
  
  METHODS
  Meta-analysis of 19 international studies.
  
  
  METHODS
  Total of 1019 patients with superficial EC (SEC).
  
  
  METHODS
  EUS and EMR or surgical resection of SEC.
  
  
  METHODS
  Sensitivity and specificity of EUS in accurately staging SEC.
  
  
  RESULTS
  The pooled sensitivity, specificity, and positive and negative likelihood ratio of EUS for T1a staging were 0.85 (95% CI, 0.82-0.88), 0.87 (95% CI, 0.84-0.90), 6.62 (95% CI, 3.61-12.12), and 0.20 (95% CI, 0.14-0.30), respectively. For T1b staging, these results were 0.86 (95% CI, 0.82-0.89), 0.86 (95% CI, 0.83-0.89), 5.13 (95% CI, 3.36-7.82), and 0.17 (95% CI, 0.09-0.30), respectively. The area under the curve was at least 0.93 for both mucosal and submucosal lesions.
  
  
  CONCLUSIONS
  Heterogeneity was present among the studies.
  
  
  CONCLUSIONS
  Overall EUS has good accuracy (area under the curve ≥0.93) in staging SECs. Heterogeneity among the included studies suggests that multiple factors including the location and type of lesion, method and frequency of EUS probe, and the experience of the endosonographer can affect the diagnostic accuracy of EUS.
authors: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School, Houston, Texas 77030, USA.
authors: Nirav
authors: N
authors: Thosani
authors: Harvinder
authors: H
authors: Singh
authors: Asha
authors: A
authors: Kapadia
authors: Nobuo
authors: N
authors: Ochi
authors: Jeffrey H
authors: JH
authors: Lee
authors: Jaffer
authors: J
authors: Ajani
authors: Stephen G
authors: SG
authors: Swisher
authors: Wayne L
authors: WL
authors: Hofstetter
authors: Sushovan
authors: S
authors: Guha
authors: Manoop S
authors: MS
authors: Bhutani
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D009361:Neoplasm Invasiveness; D012680:Sensitivity and Specificity