Staging accuracy of esophageal cancer by endoscopic ultrasound: A meta-analysis and systematic review

Table 1 Characteristics of studies included in this analysis

	Author	Year of publication	Type of enrolment	Confirmatory test
1	Takemoto et al	1986	Consecutive	Surgery
2	Tio et al	1986	Prospective	Surgery
3	Murata et al	1988	Consecutive	Surgery
4	Tio et al	1989	Prospective	Surgery
5	Vilgrain et al	1990	Consecutive	Surgery
6	Botet et al	1991	Consecutive	Surgery
7	Tio et al	1989	Prospective	Surgery
8	Heintz et al	1991	Consecutive	Surgery
9	Rice et al	1991	Consecutive	Surgery
10	Ziegler et al	1991	Consecutive	Surgery
11	Tio et al	1990	Consecutive	Surgery
12	Fok et al	1992	Consecutive	Surgery
13	Rosch et al	1992	Consecutive	Surgery
14	Dittler et al	1993	Consecutive	Surgery
15	Grimm et al	1993	Prospective	Surgery
16	Hordijik et al	1993	Consecutive	Surgery
17	Yoshikane et al	1993	Consecutive	Surgery
18	Catalano et al	1994	Consecutive	Surgery
19	Greenberg et al	1994	Prospective	Surgery
20	Peters et al	1994	Consecutive	Surgery
21	Binmoeller et al	1995	Prospective	Surgery
22	Kallimanis et al	1995	Consecutive	Surgery
23	McLoughlin et al	1995	Consecutive	Surgery
24	Francois et al	1996	Consecutive	Surgery
25	Hasegawa et al	1996	Consecutive	Surgery
26	Holden et al	1996	Consecutive	Surgery
27	Hunerbein et al	1996	Consecutive	Surgery
28	Massari et al	1996	Prospective	Surgery
29	Natsugoe et al	1996	Consecutive	Surgery
30	Vikers et al	1997	Consecutive	Surgery
31	Shimizu et al	1997	Consecutive	Surgery
32	Pham et al	1998	Consecutive	Surgery
33	Vikers et al	1998	Prospective	Surgery
34	Browney et al	1999	Prospective	Surgery
35	Catalano et al	1999	Prospective	Surgery
36	Nishimaki et al	1999	Consecutive	Surgery
37	Salminen et al	1999	Consecutive	Surgery
38	Giovannini et al	1999	Prospective	Surgery
39	Krasna et al	1999	Consecutive	Surgery
40	Heidemann et al	2000	Consecutive	Surgery
41	Nesje et al	2000	Prospective	Surgery
42	Vazquez-Sequeiros et al	2001	Consecutive	Surgery
43	Wiersema et al	2001	Prospective	Surgery
44	Kienle et al	2002	Prospective	Surgery
45	Wakelin et al	2002	Consecutive	Surgery
46	Schwartz et al	2002	Consecutive	Surgery
47	Wu et al	2003	Prospective	Surgery
48	Shimoyama et al	2004	Consecutive	Surgery
49	DeWitt et al	2005	Prospective	Surgery

Table 2 Accuracy of EUS with CIs to diagnose T stage in esophageal cancer

	Pooled sensitivity (%)	Pooled specificity (%)	Pooled LR+	Pooled LR-	Pooled DOR
T1	81.6 (77.8-84.9)	99.4 (99.0-99.7)	44.4 (15.5-127.4)	0.2 (0.2-0.4)	221.5 (118.5-413.9)
T2	81.4 (77.5-84.8)	96.3 (95.4-97.1)	16.6 (9.3-29.7)	0.2 (0.2-0.3)	90.7 (48.3-170.5)
T3	91.4 (89.5-93.0)	94.4 (93.1-95.5)	12.5 (7.7-20.3)	0.1 (0.1-0.2)	145.2 (90.3-233.4)
T4	92.4 (89.2-95.0)	97.4 (96.6-98.0)	25.4 (13.7-47.0)	0.1 (0.1-0.2)	250.0 (145.2-430.5)

LR+: Positive likelihood ratio; LR-: Negative likelihood ratio; DOR: Diagnostic odds ratio.

Table 3 Pooled estimate of accuracy of EUS alone and EUS-FNA in nodal staging of esophageal cancer with 95% CIs

	EUS	EUS-FNA
Studies	44	4
Pooled sensitivity (%)	84.7 (82.9-86.4)	96.7 (92.4-98.9)
Pooled specificity (%)	84.6 (83.2-85.9)	95.5 (91.0-98.2)
Positive likelihood ratio	3.3 (2.6-4.3)	7.3 (0.9-54.3)
Negative likelihood ratio	0.24 (0.9-0.3)	0.05 (0.01-0.64)
Diagnostic odds ratio	19.1 (12.7-28.5)	164.5 (4.5-6027.7)

Table 4 Accuracy of EUS with CIs to stage esophageal cancer over the past two decades

	Year	No. of studies	Pooled sensitivity (%)	Pooled specificity (%)	Pooled LR+	Pooled LR-	Pooled DOR
T1	1986-1944	17	80.4 (75.2-84.8)	99.2 (98.4-99.7)	41.5 (6.1-283.3)	0.25 (0.14-0.43)	181.9 (60.7-545.7)
	1995-1999	11	83.9 (76.0-90.0)	99.4 (98.4-99.8)	36.4 (18.5-71.6)	0.21 (0.09-0.47)	299.9 (107.8-834.1)
	2000-2006	8	82.4 (72.6-89.8)	100.0 (99.1-100.0)	59.5 (22.0-161.1)	0.27 (0.16-0.47)	261.2 (81.4-838.0)
T2	1986-1994	17	85.2 (80.2-89.4)	96.8 (95.5-97.8)	18.6 (5.9-58.6)	0.19 (0.12-0.30)	123.9 (47.7-322.0)
	1995-1999	13	86.8 (79.7-92.1)	97.4 (95.8-98.5)	16.9 (9.1-31.1)	0.20 (0.11-0.38)	139.5 (56.6-343.8)
	2000-2006	8	62.9 (52.0-72.9)	93.4 (90.4-95.6)	8.3 (4.3-15.9)	0.47 (0.34-0.64)	24.7 (9.1-67.4)
T3	1986-1994	18	90.8 (88.1-93.0)	94.6 (92.6-96.2)	13.9 (5.2-36.9)	0.12 (0.07-0.19)	157.7 (70.9-351.1)
	1995-1999	14	93.7 (90.0-96.3)	96.4 (94.5-97.7)	12.6 (7.6-20.9)	0.11 (0.08-0.17)	159.4 (77.9-326.2)
	2000-2006	8	89.9 (84.5-93.9)	90.0 (86.1-93.2)	7.0 (4.6-10.8)	0.11 (0.04-0.32)	100.9 (33.5-303.9)
T4	1986-1994	18	92.1 (87.9-95.2)	96.9 (95.6-97.9)	24.7 (8.4-72.7)	0.09 (0.04-0.23)	278.8 (97.2-799.9)
	1995-1999	14	89.2 (79.8-95.2)	98.0 (96.7-98.96)	22.2 (13.2-37.3)	0.23 (0.15-0.36)	227.1 (89.7-575.0)
	2000-2006	8	100.0 (91.8-100.0)	97.5 (95.4-98.8)	20.2 (8.8-46.3)	0.11 (0.04-0.29)	272.6 (73.4-1013.2)
N	1986-1994	17	88.0 (85.4-90.2)	85.2 (83.4-86.9)	3.6 (2.4-5.4)	0.2 (0.1-0.3)	27.6 (14.6-52.4)
	1995-1999	17	82.6 (78.0-85.9)	84.4 (81.6-86.9)	3.0 (2.1-4.5)	0.3 (0.2-0.4)	14.8 (7.5-29.3)
	2000-2005	10	81.6 (77.8-85.1)	82.4 (78.2-86.1)	3.4 (2.2-5.3)	0.3 (0.2-0.4)	14.9 (6.7-33.1)

Table 5 Bias indicators and AUC with the corresponding Q values for various cancer stages

	Begg-Mazumdar bias (Kendall's tau value, P)	Egger bias (95% CI, P)	AUC (SE)	Q (SE)
T1	-0.51, P = 0.01	-0.48 (95% CI = -2.84 to 1.88, P = 0.68)	0.97 (0.02)	0.91 (0.02)
T2	-0.14, P = 0.24	-0.32 (95% CI = -1.74 to 1.10, P = 0.65)	0.95 (0.02)	0.89 (0.02)
T3	-0.11, P = 0.32	0.33 (95% CI = -1.43 to 2.09, P = 0.70)	0.97 (0.01)	0.92 (0.01)
T4	-0.07, P = 0.56	-2.89 (95% CI = -5.35 to -0.44, P = 0.02)	0.98 (0.01)	0.93 (0.01)
N	-0.26, P = 0.01	0.29 (95% CI = -1.58 to 1.00, P = 0.69)	0.91 (0.02)	0.99 (0.02)