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超声內镜检查在区分浅表食管癌黏膜与黏膜下浸润中的诊断准确性:一项系统性回顾和Meta分析

发布日期:2014-1-29 12:40:24 文章来源:GIE 作者次数:1364
    超声內镜检查在区分浅表食管癌黏膜与黏膜下浸润中的诊断准确性:一项系统性回顾和Meta分析

    背景

    食管癌EC的预后取决于肿瘤浸润深度和淋巴结转移情况。限于黏膜层(T1 a)的食管癌(EC)可以通过微创內镜疗法有效治疗,然而黏膜下(T1b)食管癌发生淋巴结转移风险相对较高,需要外科手术切除。

    目的

    确定內镜超声检查(EUS在区分T1aECT1b EC中的诊断准确性。

    设计

    我们对MEDLINESCOPUSCochrane,和护理全文资料库进行了全面搜索,以此确定那些研究,这些研究中对基于EUS的食管癌级结果与內镜下黏膜切除术的组织病理学检查结果或外科切除的食管病变结果进行了比较。本研究采用DerSimonian-Laird随机效应模型估计综合敏感性,特异性和似然比,而且还绘制了一条综合受试者工作特征(SROC)曲线

    环境

    19个国际性研究Meta分析。

    患者

    1019浅表食管癌患者SEC)。

    干预

    浅表食管癌的內镜超声检查(EUS)与內镜下黏膜切除或外科切除

    主要测量指标

    SEC准确分期中的EUS的敏感性和特异性。

    结果

    T1a食道癌来说,EUS的综合敏感性,特异性,阳性与阴性似然比分别为0.8595%置信区间为0.82-0.88),0.8795CI0.84-0.90),6.6295CI3.61-12.12),0.2095CI0.14-0.30)。对T1 b期食道癌来说,这些指标结果分别为0.8695CI0.82-0.89),0.8695CI0.83-0.89),5.1395CI3.36-7.82),0.1795CI0.09-0.30 )。同时黏膜和黏膜下病变曲线下面积均不小于0.93

    局限性

    这些研究之间存在异质性。

    结论

    总的来说,在浅表食管癌分期方面,EUS具有良好的准确度(曲线下面积大于等于0.93)。所纳入的研究之间的异质性表明,病变位置和类型,EUS探针方法和频率,以及内镜超声检查者的经验等多种因素影响EUS诊断的准确性。

    缩写词:AUC,曲线下面积;Cl,置信区间;DOR,诊断优势比;EC,食管癌;ESD,內镜黏膜下剥离术;NLR,阴性似然比;PLR,阳性似然比;SCC鳞状细胞癌;SEC,浅表食管癌;SROC综合受试者工作特征(SROC)。

     

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    Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis

    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.

    Design

    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.

    Setting

    Meta-analysis of 19 international studies.

    Patients

    Total of 1019 patients with superficial EC (SEC).

    Interventions

    EUS and EMR or surgical resection of SEC.

    Main Outcome Measurements

    Sensitivity and specificity of EUS in accurately staging SEC.

    Results

    The pooled sensitivity, specificity, and positive and negative likelihood ratio of EUS for T1astaging 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.

    Limitations

    Heterogeneity was present among the studies.

    Conclusion

    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.

    Abbreviations:  AUC, area under the curve, CI, confidence interval, DOR, diagnostic odds ratio, EC, esophageal cancer, ESD, endoscopic submucosal dissection, NLR, negative likelihood ratio, PLR, positive likelihood ratio, SCC, squamous cell carcinoma, SEC, superficial esophageal cancer, SROC, summary receiver operating characteristic

     

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