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BRIEF REPORT
Year : 2014  |  Volume : 10  |  Issue : 8  |  Page : 319-322

Diagnostic value of endorectal ultrasonography for rectal carcinoma: A meta-analysis


Department of Clinical Laboratory, The 2nd People's Hospital of Tianjin, Tianjin 300192, China

Date of Web Publication17-Feb-2015

Correspondence Address:
Wei Lu
Department of Clinical Laboratory, The 2nd People's Hospital of Tianjin, Tianjin 300192
China
Yonghe Zhou
Department of Clinical Laboratory, The 2nd People's Hospital of Tianjin, Tianjin 300192
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.151542

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 > Abstract 

Objective: The aim of this meta-analysis was to evaluate the diagnosis efficacy of endorectal ultrasonography (ERUS) for rectal carcinoma.
Materials and Methods: We searched all the published articles about ERUS in evaluation of rectal carcinoma in the electronic databases. The pooled diagnosis sensitivity, specificity, diagnosis odds ratio, a positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic (ROC) were calculated by MetaDiSc-1.4 software.
Results: Fourteen studies with 1583 subjects meeting the inclusion criteria were recruited in this meta-analysis. For tumor invasion evaluated by ERUS, the pooled diagnosis sensitivity, specificity, diagnosis odds ratio, positive likelihood ratio, negative likelihood ratio and area under the ROC were 0.95 (0.92-0.97), 0.80 (0.71-0.86), 62.88 (9.30-425.33), 3.66 (2.48-5.39), 0.07 (0.01-0.40), and 0.86; for lymph node involvement evaluated by EU, the pooled diagnosis sensitivity, specificity, diagnosis odds ratio, positive likelihood ratio, negative likelihood ratio and area under the ROC were 0.58 (0.53-0.63), 0.80 (0.77-0.84), 5.93 (4.07-8.63), 2.85 (2.30-3.52), 0.54 (0.46-0.63) and 0.78.
Conclusion: ERUS was a good method for the assessment of invasion of rectal tumors and lymph node involvement.

Keywords: Endorectal ultrasonography, lymph node involvement, meta-analysis, rectal cancer, tumor invasion


How to cite this article:
Zhou Y, Shao W, Lu W. Diagnostic value of endorectal ultrasonography for rectal carcinoma: A meta-analysis. J Can Res Ther 2014;10, Suppl S4:319-22

How to cite this URL:
Zhou Y, Shao W, Lu W. Diagnostic value of endorectal ultrasonography for rectal carcinoma: A meta-analysis. J Can Res Ther [serial online] 2014 [cited 2020 Jun 1];10:319-22. Available from: http://www.cancerjournal.net/text.asp?2014/10/8/319/151542


 > Introduction Top


Rectal cancer is one of the most common diagnosed carcinoma in human beings. With the development of China's economic, people's lifestyle has been changed with more calories intake and less labor. This was one of the most important reason for the increasing incidence of colorectal cancer.

Surgery is an important treatment procedure for patients with rectal cancer. And preoperative clinical staging of rectal tumors is very important to allow surgeons make informed decisions about the types of surgeries that should be performed. [1] Endorectal ultrasonography (ERUS) is one of the tools that has been commonly used in clinical staging of rectal tumors. [1] But with small number cases in each individual trial and different study design, the exact clinical value of ERUS for evaluation the tumor invasion and lymph node involvement in rectal cancer was not clear. The aim of this study was to evaluate the accuracy of ERUS in patients with rectal cancer by meta-analysis.


 > Materials and methods Top


Publication selection

The diagnosis articles about ERUS in evaluation of rectal carcinoma were searched and identified through the electronic databases of PubMed, EMBASE, China National Knowledge Infrastructure and Wanfang. The searching terms were: Rectal cancer, rectal carcinoma, ERUS, and ERUS. The references of these publications were also manually searched in order to retrieve additional studies.

Inclusion criteria

The inclusion criteria were: (1) The study design was prospective diagnosis study; (2) the tumor invasion and lymph node involvement were confirm by surgery; (3) the true positive, false positive, false negative and true negative data can be drawn from each individual study. (4) Studies were published in English or Chinese.

Data collection

The detailed information and data to evaluation the efficacy of ERUS for rectal cancer were extracted separated by two reviewers and finally confirmed by the third reviewer. The general information of the first author, the year of publication, the diagnosis true positive, false positive, false negative and true negative were extracted for each study.

Meta-analysis and statistical analysis

Statistical software MetaDiSc-1.4 (http://www.hrc.es/investigatcion/metadisc_en.htm) was used to do the statistical analysis. Statistical heterogeneity was calculated by Chi-square test, [2] if heterogeneity was found (P < 0.05 or I2 > 50%), the random effect method was used to pool the data. And if no significant heterogeneity was found, the fixed-effect method was used.


 > Results Top


Study characteristics

Followed by the inclusion criteria, 14 studies with 1583 subjects were recruited in this meta-analysis. The detailed information was showed in [Table 1].
Table 1: The general information of included studies

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Diagnosis value for T stage

Five studies reported the diagnosis efficacy of ERUS for tumor invasion in patients with rectal cancer. [4],[5],[6],[7],[8] The aggregated sensitivity and specificity were 0.95 (95% confidence interval [CI]: 0.92-0.97) and 0.80 (95% CI: 0.71-0.86) respectively with randomized effect model for sensitivity and fixed effect model for specificity [Figure 1]. The diagnosis odds ratio of ERUS and area under the receiver operating characteristic (ROC) for tumor invasion in patients with rectal cancer was 62.88 (9.30-425.33) and 0.86 respectively [Figure 2].
Figure 1: The diagnosis sensitivity and specificity for T stage

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Figure 2: The receiver operating characteristic cure of endorectal ultrasonography for rectal carcinoma in evaluation of T stage

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Diagnosis value for N stage

Twelve studies reported the diagnosis efficacy of ERUS for lymph node involvement in patients with rectal cancer. [1],[2],[3],[9],[10],[11],[12],[13],[14] The aggregated sensitivity and specificity were 0.95 (95% CI: 0.92-0.97) and 0.80 (95% CI: 0.77-0.84) respectively with fixed effect model [Figure 3]. The diagnosis odds ratio of ERUS and area under the ROC for tumor invasion in patients with rectal cancer were 5.93 (4.07-8.63) and 0.78 respectively [Figure 4].
Figure 3: The diagnosis sensitivity and specificity for N stage

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Figure 4: The receiver operating characteristic curve of endorectal ultrasonography for rectal carcinoma in evaluation of N stage

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 > Discussion Top


In the past 20 years, the treatment strategy for rectal cancer has changed from local excision to radical rectal resection with lymph node clearance. [16] Thus, the preoperative clinical evaluation of tumor invasion and lymph node involvement is important to determine the treatment strategy for patients with rectal tumors. [17] In general, the digital rectal examination, computed tomography, magnetic resonance imaging and enteroscopy were common used for evaluation the preoperative staging of rectal cancer. ERUS has been reported useful for clinical preoperative tumor evaluation in tumor invasion depth and lymph node involvement. The continued evolution of this instrument will make ERUS more accurate in staging and allow physicians to become more familiar with it. [1] There were various reports on the accuracy of the depth of tumor invasion and nodal involvement in ERUS assessments, but results were not conclusive.

We performed this meta-analysis in order to aggregate all the published data about the clinical efficacy of ERUS in evaluation the preoperative tumor invasion and lymph node involvement for rectal cancer. From the results of this meta-analysis, we can find that the general diagnosis efficacy of ERUS for evaluation of tumor invasion and lymph involvement were relative acceptable. ERUS for evaluation of tumor invasion was better than it for lymph involvement in the aspect of diagnosis sensitivity and specificity. It indicated that the ERUS was more suitable for evaluation of tumor invasion other than lymph node involvement.

 
 > References Top

1.
Hsieh PS, Changchien CR, Chen JS, Tang R, Chiang JM, Yeh CY, et al. Comparing results of preoperative staging of rectal tumor using endorectal ultrasonography and histopathology. Chang Gung Med J 2003;26:474-8.  Back to cited text no. 1
    
2.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.  Back to cited text no. 2
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3.
Hildebrandt U, Feifel G, Schwarz HP, Scherr O. Endorectal ultrasound: Instrumentation and clinical aspects. Int J Colorectal Dis 1986;1:203-7.  Back to cited text no. 3
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4.
Sunouchi K, Sakaguchi M, Higuchi Y, Namiki K, Muto T. Limitation of endorectal ultrasonography: What does a low lesion more than 5 mm in size correspond to histologically? Dis Colon Rectum 1998;41:761-4.  Back to cited text no. 4
    
5.
Rifkin MD, Ehrlich SM, Marks G. Staging of rectal carcinoma: Prospective comparison of endorectal US and CT. Radiology 1989;170:319-22.  Back to cited text no. 5
    
6.
Glaser F, Schlag P, Herfarth C. Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement. Br J Surg 1990;77:883-7.  Back to cited text no. 6
    
7.
Akasu T, Kondo H, Moriya Y, Sugihara K, Gotoda T, Fujita S, et al. Endorectal ultrasonography and treatment of early stage rectal cancer. World J Surg 2000;24:1061-8.  Back to cited text no. 7
    
8.
Hünerbein M, Pegios W, Rau B, Vogl TJ, Felix R, Schlag PM. Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors. Preliminary results. Surg Endosc 2000;14:1005-9.  Back to cited text no. 8
    
9.
Lindmark G, Elvin A, Påhlman L, Glimelius B. The value of endosonography in preoperative staging of rectal cancer. Int J Colorectal Dis 1992;7:162-6.  Back to cited text no. 9
    
10.
Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum 1999;42:770-5.  Back to cited text no. 10
    
11.
Radovanovic Z, Radovanovic D, Breberina M, Petrovic T, Golubovic A, Bokorov B. The value of endorectal ultrasonography in rectal cancer staging. Med Pregl 2008;61:557-61.  Back to cited text no. 11
    
12.
Martino D, Martino P, Balena V, Spilotros M, Catalano G, Palazzo S, et al. The role of endorectal ultrasonography in preoperative staging of rectal cancer. Arch Ital Urol Androl 2010;82:256-8.  Back to cited text no. 12
    
13.
Zhang CS, Xiang YP, Wang L. Endorectal ultrasound in preoperative evaluation on perirectal lymph node involvement in patients with rectal carcinoma. Chin J Med Imaging Technol 2013;29:247-50.  Back to cited text no. 13
    
14.
Liu ZL, Liang XB, Ma JJ, Jiang HY. Accuracy of endorectal ultrasonography in preoperative staging of rectal cancer. Zhonghua Wai Ke Za Zhi 2013;51:701-5.  Back to cited text no. 14
    
15.
Zhong GX, Dai Q, Jiang YX, Xiao Y, Qiu HZ. Value of endorectal ultrasonography in preoperative staging of rectal cancer. Chin J Bases Clin Gen Surg 2010;17:901-5.  Back to cited text no. 15
    
16.
Fung-Kee-Fung SD. Therapeutic approaches in the management of locally advanced rectal cancer. J Gastrointest Oncol 2014;5:353-61.  Back to cited text no. 16
    
17.
Guo J, Liu Z, Sun S, Wang S, Ge N, Liu X, et al. Endosonography-assisted diagnosis and therapy of gastrointestinal submucosal tumors. Endosc Ultrasound 2013;2:125-33.  Back to cited text no. 17
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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