Meta-Analysis
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World J Gastroenterol. Sep 21, 2014; 20(35): 12649-12656
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12649
Kudo’s pit pattern classification for colorectal neoplasms: A meta-analysis
Ming Li, Syed Mohsin Ali, Syeda Umm-a-OmarahGilani, Jing Liu, Yan-Qing Li, Xiu-Li Zuo
Ming Li, Syed Mohsin Ali, Syeda Umm-a-OmarahGilani, Jing Liu, Yan-Qing Li, Xiu-Li Zuo, Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Li M, Ali SM contributed equally to this manuscript; Li M designed the research and critically revised the manuscript; Ali SM, Umm-a-OmarahGilani S and Liu J performed the research; Li M contributed analytic tools; Li M and Ali SM analyzed the data; Ali SM wrote the paper; Li YQ and Zuo XL approved, supervised and financially supported this study.
Correspondence to: Xiu-Li Zuo, Professor, Department of Gastroenterology, Qilu Hospital, Shandong University, 107 Wen Hua Xi Road, Jinan 250012, Shandong Province, China. xiulizuo@gmail.com
Telephone: +86-531-82169381 Fax: +86-531-82166090
Received: November 30, 2013
Revised: April 3, 2014
Accepted: May 12, 2014
Published online: September 21, 2014
Abstract

AIM: To analyze the current available evidence of Kudo’s pit pattern classification for diagnosing colorectal neoplasms.

METHODS: A search was performed on Pubmed/Embase to identify studies reporting the outcomes of the pit pattern classification in colorectal polyps. Retrieved records were evaluated and selected by two independent investigators. The number of patients, polyps and diagnostic performance of Kudo’s pit pattern classification were retrieved from suitable studies. Pooled sensitivities and specificities were calculated using fixed or random effect models according to their heterogeneity. Publication bias was evaluated using funnel plot, Egger’s test, and Begg’s test. Sensitivity analysis was performed by omitting one study at a time and selecting a subgroup consisting of 11 magnifying chromoendoscopy studies.

RESULTS: 20 eligible studies were included in which a total of 5111 colorectal lesions in 3418 patients were identified for the differentiation of neoplastic and non-neoplastic polyps. Pit pattern classification in all the studies of mucosal patterns with magnification resulted in a pooled sensitivity of 89.0% (95%CI: 85.2-91.9) and pooled specificity of 85.7% (95%CI: 81.3-89.2) and the area under the SROC curve was 0.9354. There was significant publication bias (P = 0.038 and 0.006 for sensitivity and specificity using Egger’s test, P = 0.035 and 0.139 for sensitivity and specificity using Begg’s test, respectively). No single study significantly affected the pooled result, and the magnifying chromoendoscopy subgroup yielded a sensitivity of 92.7% (95%CI: 89.2-95.2) and specificity of 87.3% (95%CI: 81.6-91.4).

CONCLUSION: Kudo’s pit pattern classification is an accurate diagnostic method for the differentiation of neoplastic colorectal lesions. Publication bias is significant in the current available literature.

Keywords: Meta-analysis, Sensitivity, Specificity, Colonic neoplasia, Endoscope, Magnifying endoscopy

Core tip: According to the current available evidence, Kudo’s pit pattern classification is an accurate diagnostic method for the differentiation of neoplastic and non-neoplastic colorectal lesions. The risk of potential publication bias should be noted.