| Objective :To compare the diagnostic value of endovenous ultrasound(ERUS)and magnetic resonance imaging(MRI)in preoperative T and N staging of rectal cancer by systematic analysis of Meta analysis,and providing the evidence-based evidence for accurate preoperative staging of rectal cancer,then guiding the individualized treatment of patients with rectal cancer.So it can reduce the suffering and economic burden of patients,and save medical resources to avoid overtreatment and undertreatment.Materials and methods:Wanfang data,CNKI,VIP,SinoMed,PubMed,EMBASE,Cochrane Database of Clinical Trails were selected.The literatures selected were published during the period from January 1,2006 to June 30,2017.We used a combination of keywords related to the("magnetic resonance imaging" OR("magnetic" AND "resonance" AND "imaging")OR "magnetic resonance imaging" OR "mri")OR(endorectal OR "ultrasonography" OR "ultrasonography" or “ERUS”)AND("rectal neoplasms" OR "rectal cancer").Inclusion criteria:(1)Study on the diagnosis of ultrasonography and magnetic resonance imaging in preoperative TNM staging of rectal cancer;(2)All the study must be confirmed rectal cancer by preoperative endoscopic biopsy;(3)The data can be extracted and calculated for the four grid data.And the 2X2 contingency table can be constructed,which include true positive,false positive,false negative and true negative data.(4)More than 20 patients were includedThe methodological qualities of studies included were evaluated by Quality Assessment Diagnostic Accuracy Study(QUADAS).Meta-Disc1.4 and Stata software/SE 12.0 were used for data analysis.Standard chi-square test and I2 statistic were used to assess heterogeneity.if I2 ?50%(P>0.10)fix-effect model was used to statistical analysis.Or randomized was used.And then mesh the sensitivity,specificity,likelihood ratio,diagnostic odds ratio of ERUS and MRI on rectal cancer staging by the model.And then we can draw the ummary receiver operating characteristic(SROC)and calculate the Area Under the Curve(AUC).Result:There are 10 Chinese literatures and 3 English literatures selected in our research for T staging analysis,which included 1836 patients.And the heterogeneity test show no heterogeneity(c2 = 7.02,df = 12(P = 0.86);I2 = 0%),applying fixed effects model,OR combination =0.85,95%CI[0.69,1.07] P=0.16.So we sure that there are no statistic difference in accuracy rate of diagnosis of T staging between MRI and ERUS.Meta analysis of T staging showed that ERUS diagnostic value was superior to MRI in T1-2 staging.(1)the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of MRI for T1 diagnosis were: 0.95(95% CI 0.93-0.97),0.72(95% CI 0.60-0.81),14.46(95% CI 9.96-21.00),0.30(95% CI 0.21-0.43),43.75(95% CI23.46-81.62);the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of ERUS for T1 diagnosis were:0.96(95%CI 0.95-0.98),0.75(95%CI0.65-0.83),21.49(95%CI13.73-33.64),0.21(95%CI 0.02-1.82),and 87.47(95%CI 30.24-253.07).(2)the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of MRI for T2 diagnosis were: 0.90(95% CI 0.88-0.93),0.64(95% CI 0.57-0.71),6.84(95% CI 5.14-9.11),0.40(95% CI 0.33-0.48),17.17(95% CI 11.62-25.37);the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of ERUS for T2 diagnosis were:0.91(95% CI,0.88-0.93),0.74(95% CI 0.67-0.79),6.89(95% CI 3.78-12.57),0.35(95% CI 0.21-0.58),22.13(95% CI,8.49-57.64).MRI has similar diagnostic value with ERUS for T3 stage;(3)the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of MRI for T3 diagnosis were: 0.83(95% CI 0.80-0.86),0.81(95% CI 0.77-0.85),4.42(95% CI 3.12-6.27),0.24(95% CI 0.19-0.29),20.67(95% CI 14.59-29.27);the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of ERUS for T3 diagnosis were: 0.84(95% CI,0.81-0.87),0.82(95% CI 0.77-0.86),4.73(95% CI 2.82-7.93),0.23(95% CI 0.18-0.28),24.27(95% CI 16.62-35.45);.MRI is better than ERUS for T4 stage,(4)the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of MRI for T4 diagnosis were: 0.95(95% CI 0.94-0.97),0.83(95% CI 0.77-0.88),12.34(95% CI 8.83-17.23),0.18(95% CI 0.13-0.26),65.31(95% CI 37.69-113.18);the specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratioof ERUS for T4 diagnosis were: 0.96(95% CI 0.94-0.97),0.82(95% CI 0.75-0.88),16.19(95% CI 10.78-24.31),0.23(95% CI 0.14-0.39),92.06(95% CI,49.66-170.66).There are 11 researches selected in our study about the accuracy rate of diagnosis of N staging,which including 759 patients in MRI group and 734 patients in EURS group.heterogeneity test also show no heterogeneity(c2 = 7.72,df = 10(P = 0.66);I2 = 0%).Applying fixed effects model,two groups also have no statistical differences in N staging accuracy(OR combination =1.15,[0.93,1.43] P=0.2).Diagnostic value in N staging,MRI is superior to the ERUS.(1)The specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of MRI for the N phase were: 0.75(95% CI 0.69 0.80),0.64(95% CI 0.57-0.71),2.29(95% CI 1.51-3.49),0.49(95% CI 0.41-0.59),5.37(95% CI 3.64-7.93);(2)The specificity,sensitivity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of ERUS for N phase diagnosis were: 0.66(95% CI 0.60-0.72),0.6(95% CI 0.52-0.67),1.77(95% CI 1.45-2.18),0.60(95% CI 0.49-0.74),3.05(95% CI 2.09-4.46).Conclusion:1.The total accuracy of T staging by magnetic resonance and intraluminal ultrasound is equivalent,and the diagnostic value of T1-2 phase intraluminal ultrasound is better than that of magnetic resonance.The diagnostic value of two cases in phase T3 is almost identical,while phase T4 magnetic resonance is slightly better than that of intraluminal ultrasound.2.The total accuracy of magnetic resonance and intraluminal ultrasound in N staging of rectal cancer is similar,but the diagnostic value of magnetic resonance is better than that of intraluminal ultrasound. |
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