|Year : 2014 | Volume
| Issue : 8 | Page : 319-322
Diagnostic value of endorectal ultrasonography for rectal carcinoma: A meta-analysis
Yonghe Zhou, Wei Shao, Wei Lu
Department of Clinical Laboratory, The 2nd People's Hospital of Tianjin, Tianjin 300192, China
|Date of Web Publication||17-Feb-2015|
Department of Clinical Laboratory, The 2nd People's Hospital of Tianjin, Tianjin 300192
Department of Clinical Laboratory, The 2nd People's Hospital of Tianjin, Tianjin 300192
Source of Support: None, Conflict of Interest: None
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
| > Introduction|| |
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.  Endorectal ultrasonography (ERUS) is one of the tools that has been commonly used in clinical staging of rectal tumors.  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|| |
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.
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.
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,  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|| |
Followed by the inclusion criteria, 14 studies with 1583 subjects were recruited in this meta-analysis. The detailed information was showed in [Table 1].
Diagnosis value for T stage
Five studies reported the diagnosis efficacy of ERUS for tumor invasion in patients with rectal cancer. ,,,, 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 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. ,,,,,,,, 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 4: The receiver operating characteristic curve of endorectal ultrasonography for rectal carcinoma in evaluation of N stage|
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| > Discussion|| |
In the past 20 years, the treatment strategy for rectal cancer has changed from local excision to radical rectal resection with lymph node clearance.  Thus, the preoperative clinical evaluation of tumor invasion and lymph node involvement is important to determine the treatment strategy for patients with rectal tumors.  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.  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|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]