| Objective:To evaluate the diagnostic value of endoscopic ultrasound(EUS)and magnetic resonance imaging(MRI)in T,N staging of rectal cancer before surgery by meta-analysis,and to provide evidence-based medical evidence for accurate staging of rectal cancer before surgery,which can guide clinicians to formulate the best treatment plan for patients.Methods:Databases including Pub Med,EMBASE,The Cochrane Library,CBM,CNKI,VIP,Wanfang Data were searched for diagnostic tests about EUS and MRI on preoperative T and N staging of rectal cancer from the establishment of database to August,2019.Using the combination of Me SH subject words and free words to search.Two researchers independently screened literature and extracted data according to the inclusion and exclusion criteria.The quality of literatures was evaluated by using the quality assessment of diagnostic accuracy studies(QUADAS-2)instrument.Meta-analysis was performed by employing Stata 15.0 software.Heterogeneity of the included literatures was tested,and according to the results of heterogeneity,the corresponding effect models were selected to pooled sensitivity(SEN),specificity(SPC),positive likelihood ratio(PLR),negative likelihood ratio(NLR)and diagnostic odds ratio(DOR).Summary receiver operating characteristics curve(SROC)of EUS and MRI for T and N staging was drew and the area under the curve(AUC)was calculated.Results:A total of 10 studies involving 687 patients were included,of which 10 studies of T staging involving 619 patients,and 7 studies of N staging involving 434 patients.The results of meta analysis showed that for total T stage,the pooled SEN,SPC,PLR,NLR and DOR of EUS were respectively0.82(95%CI 0.73 to 0.88),0.93(95%CI 0.88 to 0.96),11.5(95%CI 6.3 to 20.8),0.20(95%CI 0.13 to 0.30),59(95%CI 21 to 161),and MRI in turn were 0.75(95%CI 0.64 to 0.83),0.91(95%CI 0.85 to 0.94),7.9(95%CI 4.5 to 14.0),0.28(95%CI 0.18 to 0.43),28(95%CI 11 to 77).The areas under SROC curves were 0.94(95%CI 0.92 to 0.96)and 0.91(95%CI 0.88 to 0.93)respectively.Among them,the pooled SEN,SPC,PLR,NLR,DOR of EUS for diagnosing T1 staging were 0.93(95%CI 0.80 to 0.97),0.98(95%CI 0.94 to 0.99),58.9(95%CI 14.5 to 235.2),0.08(95%CI 0.03 to 0.22),767(95%CI 109 to 1371)respectively,and MRI in turn were 0.71(95%CI 0.68 to 0.88),0.96(95%CI 0.93 to0.98),58.4(95%CI 13.2 to 233.0),0.29(95%CI 0.03 to 2.47),202(95%CI 11 to 618).For T2 staging of EUS,the pooled SEN,SPC,PLR,NLR,DOR were respectively0.81(95%CI 0.64 to 0.91),0.92(95%CI 0.85 to 0.96),10.0(95%CI 5.0 to 20.1),0.21(95%CI 0.10 to 0.43),48(95%CI 13 to 180),MRI in turn were 0.72(95%CI 0.53 to0.85),0.86(95%CI 0.73 to 0.94),5.3(95%CI 2.2 to 12.8),0.33(95%CI 0.17 to 0.63),16(95%CI 4 to 71).For T3 staging,the SEN,SPC,PLR,NLR,DOR of EUS were0.86(95%CI 0.80~0.90),0.88(95%CI 0.77 to 0.94),7.0(95%CI 3.7 to 13.4),0.16(95%CI 0.11 to 0.23),44(95%CI 19 to 102)respectively,and MRI in turn were0.79(95%CI 0.65 to 0.88),0.85(95%CI 0.76 to 0.91),5.3(95%CI 3.0 to 9.7),0.24(95%CI 0.13 to 0.45),22(95%CI 7 to 70).For T4 staging,the pooled SEN,SPC,PLR,NLR,and DOR of EUS were 0.63(95%CI 0.51 to 0.91),0.91(95%CI 0.88 to 0.96),10.1(95%CI 7.6 to 18.1),0.38(95%CI 0.12 to 1.18)and 73(95%CI 12 to 453)respectively,MRI in turn were 0.88(95%CI 0.82 to 0.98),0.94(95%CI 0.89 to 0.97)),15.0(95%CI 6.9 to 32.9),0.13(95%CI 0.02 to 0.70),114(95%CI 13 to 615).As for N staging,the pooled SEN,SPC,PLR,NLR,and DOR of EUS were 0.63(95%CI0.48 to 0.75),0.81(95%CI 0.73 to 0.87),3.2(95%CI 2.2 to 4.8),0.46(95%CI 0.32 to0.67),7(95%CI 4 to 14)respectively,while MRI were 0.74(95%CI 0.61 to 0.83),0.80(95%CI 0.73 to 0.86),3.8(95%CI 2.7 to 5.2),0.33(95%CI 0.22 to 0.50),11(95%CI 6 to 21),the areas under the curves of the SROC were 0.81(95%CI 0.77 to0.84)and 0.84(95%CI 0.81 to 0.87)respectively.Conclusion:Both EUS and MRI have excellent diagnostic value for preoperative T staging in rectal cancer,but EUS performed better in diagnosing T1-3 staging,while for T4 staging,MRI performed better than EUS.For N staging,MRI has higher diagnostic value than EUS. |
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