Chen C, Song YL, Wu ZY, Chen J, Zhang Y, Chen L. Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia: A meta-analysis. World J Gastroenterol 2023; 29(30): 4685-4700 [PMID: 37662859 DOI: 10.3748/wjg.v29.i30.4685]
Corresponding Author of This Article
Lei Chen, MD, PhD, Professor, Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Main Street, Xinqiao Street, Shapingba District, Chongqing 400038, China. chenlei_1977603@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 14, 2023; 29(30): 4685-4700 Published online Aug 14, 2023. doi: 10.3748/wjg.v29.i30.4685
Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia: A meta-analysis
Cong Chen, Ya-Lan Song, Zhen-Yu Wu, Jing Chen, Yao Zhang, Lei Chen
Cong Chen, Ya-Lan Song, Zhen-Yu Wu, Jing Chen, Lei Chen, Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
Yao Zhang, Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
Author contributions: Chen C and Chen L conceived and designed the study; Chen C and Song YL contributed to the literature search, study selection and drafted the manuscript; Chen C, Wu ZY, and Chen L extracted the data; Chen C and Chen J contributed to the quality assessment; Chen C, Song YL, and Zhang Y analyzed the data; Chen C, Wu ZY, and Chen J interpreted the data; Wu ZY edited the manuscript; Chen J revised the manuscript; Chen L and Zhang Y contributed to the critical revision; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Chen, MD, PhD, Professor, Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Main Street, Xinqiao Street, Shapingba District, Chongqing 400038, China. chenlei_1977603@126.com
Received: May 5, 2023 Peer-review started: May 5, 2023 First decision: July 9, 2023 Revised: July 16, 2023 Accepted: July 27, 2023 Article in press: July 27, 2023 Published online: August 14, 2023
Abstract
BACKGROUND
Upper gastrointestinal neoplasia mainly includes esophageal cancer and gastric cancer, both of which have high morbidity and mortality. Lymph node metastasis (LNM), as the most common metastasis mode of both diseases, is an important factor affecting tumor stage, treatment strategy and clinical prognosis. As a new fusion technology, endoscopic ultrasound (EUS) is becoming increasingly used in the diagnosis and treatment of digestive system diseases, but its use in detecting LNM in clinical practice remains limited.
AIM
To evaluate the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia.
METHODS
Using the search mode of “MeSH + Entry Terms” and according to the predetermined inclusion and exclusion criteria, we conducted a comprehensive search and screening of the PubMed, EMBASE and Cochrane Library databases from January 1, 2000 to October 1, 2022. Study data were extracted according to the predetermined data extraction form. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool, and the results of the quality assessment were presented using Review Manager 5.3.5 software. Finally, Stata14.0 software was used for a series of statistical analyses.
RESULTS
A total of 22 studies were included in our study, including 2986 patients. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic score and diagnostic odds ratio of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were 0.62 [95% confidence interval (CI): 0.50-0.73], 0.80 (95%CI: 0.73-0.86), 3.15 (95%CI: 2.46-4.03), 0.47 (95%CI: 0.36-0.61), 1.90 (95%CI: 1.51-2.29) and 6.67 (95%CI: 4.52-9.84), respectively. The area under the summary receiver operating characteristic curve was 0.80 (95%CI: 0.76-0.83). Sensitivity analysis indicated that the results of the meta-analysis were stable. There was considerable heterogeneity among the included studies, and the threshold effect was an important source of heterogeneity. Univariable meta-regression and subgroup analysis showed that tumor type, sample size and EUS diagnostic criteria were significant sources of heterogeneity in specificity (P < 0.05). No significant publication bias was found.
CONCLUSION
Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia, but it cannot be used as a confirmatory or exclusionary test.
Core Tip: This meta-analysis examined the diagnostic value of conventional endoscopic ultrasound (EUS) for lymph node metastasis (LNM) in upper gastrointestinal neoplasia. The pooled analyses of 2986 patients from 22 studies performed herein show that conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia, but it cannot be used as a confirmatory or exclusionary test. More high-quality studies are needed to further verify the diagnostic value of EUS and determine the best diagnostic criteria.
