Abstract
BackgroundTreatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable. The objective of this study was to evaluate the diagnostic accuracy of EUS for detecting preoperative ESCC.MethodsWe included in our meta-analysis studies involving EUS-based staging of preoperative ESCC compared with pathological staging. Using a random-effects model, we performed a meta-analysis of the accuracy of EUS by calculating pooled estimates of sensitivity, specificity and the diagnostic odds ratio. In addition, we created a summary receiver operating characteristic (SROC) curve.ResultsForty-four studies (n = 2880) met the inclusion criteria. The pooled sensitivity and specificity of T1 were 77% (95%CI: 73 to 80) and 95% (95%CI: 94 to 96). Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%CI: 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92). To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97). The overall accuracy of EUS for T-staging was 79% (95%CI: 77 to 80), and for N-staging, 71% (95%CI: 69 to 73).ConclusionsEUS has good diagnostic accuracy for staging ESCC, which has better performance in T1 sub-staging (T1a and T1b) and advanced disease (T4).
Highlights
We included in our meta-analysis studies involving Endoscopic ultrasound (EUS)-based staging of preoperative esophageal squamous cell carcinoma (ESCC) compared with pathological staging
Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%confidence intervals (CIs): 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92)
To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97)
Summary
Esophageal cancer is one of the ten leading causes of cancer-related mortality worldwide[1]; nearly 90% of the mortality is esophageal squamous cell carcinoma (ESCC) and 70% of ESCC occurred in China. Common imaging modalities used in staging preoperative ESCC include CT, MRI, PET and EUS. CT provides importance information about tumor size and regional lymph node status. CT alone is reported to have a sensitivity of 33% in lymph node involvement[4]. EUS provides detailed information on the esophageal wall and is important in T-staging of ESCC. It is reported that the accuracy of tumor staging using EUS varies according to stages and ranges from 73% to 89% [9]. Treatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable.
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