Abstract
BackgroundDiagnosis of cancer invasion depth is crucial for selecting the optimal treatment strategy in patients with gastrointestinal cancers. We conducted a meta-analysis to determine the utilities of different endoscopic modalities for diagnosing invasion depth of esophageal squamous cell carcinoma (SCC).MethodsWe conducted a comprehensive search of MEDLINE, Cochrane Central, and Ichushi databases to identify studies evaluating the use of endoscopic modalities for diagnosing invasion depth of superficial esophageal SCC. We excluded case reports, review articles, and studies in which the total number of patients or lesions was <10.ResultsFourteen studies fulfilled our criteria. Summary receiver operating characteristic curves showed that magnified endoscopy (ME) and endoscopic ultrasonography (EUS) performed better than non-ME. ME was associated with high sensitivity and a very low (0.08) negative likelihood ratio (NLR), while EUS had high specificity and a very high (17.6) positive likelihood ratio (PLR) for the diagnosis of epithelial or lamina propria cancers. NLR <0.1 provided strong evidence to rule out disease, and PLR >10 provided strong evidence of a positive diagnosis.ConclusionsEUS and ME perform better than non-ME for diagnosing invasion depth in SCC. ME has a low NLR and is a reliable modality for confirming deep invasion of cancer, while EUS has a high PLR and can reliably confirm that the cancer is limited to the surface. Effective use of these two modalities should be considered in patients with SCC.Trial registrationPROSPERO (International Prospective Register of Systematic Reviews); number 42015024462.
Highlights
Diagnosis of cancer invasion depth is crucial for selecting the optimal treatment strategy in patients with gastrointestinal cancers
Esophagectomy has been the mainstay of treatment for superficial esophageal squamous cell carcinoma (SCC)
Search strategy We searched the MEDLINE, Cochrane Central, and Ichushi databases from January 1995 to June 2015 using the following search terms: (“esophageal cancer” OR “esophageal tumor” OR “esophageal tumor” OR “esophageal neoplasia” OR “esophageal carcinoma” OR “esophageal mucosal” OR “esophageal lamina propria”) AND (“diagnosis” OR “endosonography” OR “staining and labeling” OR “iodine” OR “magnifying endoscopy OR “chromoendoscopy” OR “NBI” OR “avascular area” OR “endoscopic ultrasound” OR “imaging” OR “pathology” OR “esophagoscopy”) AND (“neoplasm invasiveness” OR “[T1a and EP]” OR “M1” OR “Tis” OR “[T1a and LPM]” OR “M2” OR “T1a” OR “(T1a and MM)” OR “M3” OR “T1b” OR “[pT1a and MM]” OR “T1b” OR “SM” OR “SM1” OR “SM2” OR “SM3” OR “[T1b and SM] OR “vascular involvement” OR invasion OR “infiltration” OR “depth”)
Summary
Diagnosis of cancer invasion depth is crucial for selecting the optimal treatment strategy in patients with gastrointestinal cancers. We conducted a meta-analysis to determine the utilities of different endoscopic modalities for diagnosing invasion depth of esophageal squamous cell carcinoma (SCC). Esophagectomy has been the mainstay of treatment for superficial esophageal SCC. E.g. the patient’s condition, metastatic status, cancer invasion depth, and size of the lesion, must be taken into account when choosing the appropriate treatment. Among these factors, cancer invasion depth correlates well with the risk of metastasis and the curability by ER [10, 11].
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