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Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 5/2009

01.05.2009 | Gastrointestinal Oncology

Accuracy of Endoscopic Ultrasound to Diagnose Nodal Invasion by Rectal Cancers: A Meta-Analysis and Systematic Review

verfasst von: Srinivas R. Puli, MD, Jyotsna B.K. Reddy, Matthew L. Bechtold, Abhishek Choudhary, Mainor R. Antillon, William R. Brugge

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2009

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Abstract

Background

Nodal staging in patients with rectal cancer predicts prognosis and directs therapy. Published data on the accuracy of endoscopic ultrasound (EUS) for diagnosing nodal invasion in patients with rectal cancer has been inconsistent.

Aim

To evaluate the accuracy of EUS in diagnosing nodal metastasis of rectal cancers.

Method

Study Selection Criteria: Only EUS studies confirmed by surgical histology were selected. Data Collection and Extraction: Articles were searched in Medline, Pubmed, and CENTRAL. Statistical Method: Pooling was conducted by both fixed-effects model and random-effects model.

Results

The initial search identified 3610 reference articles in which 352 relevant articles were selected and reviewed. Data were extracted from 35 studies (N = 2732) that met the inclusion criteria. Pooled sensitivity of EUS in diagnosing nodal involvement by rectal cancers was 73.2% (95% confidence interval [95% CI] 70.6–75.6). EUS had a pooled specificity of 75.8% (95% CI 73.5–78.0). The positive likelihood ratio of EUS was 2.84 (95% CI 2.16–3.72), and negative likelihood ratio was 0.42 (95% CI 0.33–0.52). All the pooled estimates, calculated by fixed- and random-effect models, were similar. SROC curves showed an area under the curve of 0.79. The P for chi-squared heterogeneity for all the pooled accuracy estimates was >.10.

Conclusions

EUS is an important and accurate diagnostic tool for evaluating nodal metastasis of rectal cancers. This meta-analysis shows that the sensitivity and specificity of EUS is moderate. Further refinement in EUS technologies and diagnostic criteria are needed to improve the diagnostic accuracy.
Literatur
1.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.PubMedCrossRef
2.
3.
Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–62.PubMed
4.
Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:1679–87.PubMed
5.
Cho E, Smith-Warner SA, Ritz J, van den Brandt PA, Colditz GA, Folsom AR, et al. Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. Ann Intern Med. 2004;140:603–13.PubMed
6.
Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med. 1995;122:327–34.PubMed
7.
Paskett ED, Reeves KW, Rohan TE, Allison MA, Williams CD, Messina CR, et al. Association between cigarette smoking and colorectal cancer in the Women’s Health Initiative. J Natl Cancer Inst. 2007;99:1729–35.PubMedCrossRef
8.
Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag, 2002.
9.
Guillem JG, Chessin DB, Cohen AM, Shia J, Mazumdar M, Enker W, et al. Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005;241:829–36.PubMedCrossRef
10.
Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983;52:1317–29.PubMedCrossRef
11.
Minsky BD, Mies C, Recht A, Rich TA, Chaffey JT. Resectable adenocarcinoma of the rectosigmoid and rectum: patterns of failure and survival. Cancer. 1988;61:1408–16.PubMedCrossRef
12.
Willett CG, Lewandrowski K, Donelly S, Shellito PC, Convery K, Eliseo R, et al. Are there patients with stage I rectal carcinoma at risk for failure after abdominoperineal resection? Cancer. 1992;69:1651–5.PubMedCrossRef
13.
Law WL, Chu KW, Choi HK. Total pelvic exenteration for locally advanced rectal cancer. J Am Coll Surg. 2000;190:78–83.PubMedCrossRef
14.
Hafner GH, Herrera L, Petrelli NJ. Morbidity and mortality after pelvic exenteration for colorectal adenocarcinoma. Ann Surg. 1992;215:63–7.PubMedCrossRef
15.
Emami B, Pilepich M, Willett C, Munzenrider JE, Miller HH. Effect of preoperative irradiation on resectability of colorectal carcinomas. Int J Radiat Oncol Biol Phys. 1982;8:1295–9.PubMed
16.
Dosoretz DE, Gunderson LL, Hedberg S, Hoskins B, Blitzer PH, Shipley W, et al. Preoperative irradiation for unresectable rectal and rectosigmoid carcinomas. Cancer. 1983;52:814–8.PubMedCrossRef
17.
Mendenhall WM, Million RR, Bland KI, Pfaff WW, Copeland 3rd EM. Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery. Ann Surg. 1987;205:41–4.
18.
Stevens KR, Fletcher WS. High dose preoperative pelvic irradiation for unresectable adenocarcinoma of the rectum or sigmoid. Int J Radiat Oncol Biol Phys. 1983;9:148.
19.
Mohiuddin M, Regine WF, John WJ, Hagihara PF, McGrath PC, Kenady DE, et al. Preoperative chemoradiation in fixed distal rectal cancer: dose time factors for pathological complete response. Int J Radiat Oncol Biol Phys. 2000;46:883–8.PubMed
20.
Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys. 1999;44:1027–38.PubMed
21.
Videtic GM, Fisher BJ, Perera FE, Bauman GS, Kocha WI, Taylor M, et al. Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer. Int J Radiat Oncol Biol Phys. 1998;42:319–24.PubMed
22.
Chen ET, Mohiuddin M, Brodovsky H, Fishbein G, Marks G. Downstaging of advanced rectal cancer following combined preoperative chemotherapy and high dose radiation. Int J Radiat Oncol Biol Phys. 1994;30:169–175.PubMed
23.
Janjan NA, Crane CN, Feig BW, Cleary K, Dubrow R, Curley SA, et al. Prospective trial of preoperative concomitant boost radiotherapy with continuous infusion 5-fluorouracil for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2000;47:713–8.PubMedCrossRef
24.
Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Colorectal Dis. 2000;15:9–20.PubMedCrossRef
25.
Guinet C, Buy JN, Ghossain MA, Sezeur A, Mallet A, Bigot J-M, et al. Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer. Arch Surg. 1990;125:385–8.PubMed
26.
Rifkin MD, Ehrlich SM, Marks G. Staging of rectal carcinoma: prospective comparison of endorectal US and CT. Radiology. 1989;170:319–22.PubMed
27.
Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992;304:1491–4.PubMedCrossRef
28.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996;17:1–12.PubMedCrossRef
29.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.
30.
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.PubMedCrossRef
31.
Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PMM, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol. 2006;6:9.PubMedCrossRef
32.
Puli SR, Singh S, Hagedorn CH, Reddy J, Olyaee M. Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc. 2007;65:788–97.PubMedCrossRef
33.
Leemis LM, Trivedi KS. A comparison of approximate interval estimators for the Bernoulli parameter. Am Stat. 1996;50:63–8.CrossRef
34.
Cox DR. The analysis of binary data. London: Methuen, 1970.
35.
Agresti A. Analysis of ordinal categorical data. New York: John Wiley & Sons, 1984.
36.
Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In Egger M, Smith GD, Altman DG (eds). Systematic reviews in health care. Meta-analysis in context. London: BMJ Books, 2001.
37.
Harbord RM, Egger M, Sterne JAC. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2005;25:3443–57.CrossRef
38.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–1101.PubMedCrossRef
39.
Sterne JAC, Egger M, Davey-Smith G. Investigating and dealing with publication and other biases in meta-analysis. Br Med J. 2001;323:101–5.CrossRef
40.
Sterne JAC, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54:1046–55.PubMedCrossRef
41.
Adams DR, Blatchford GJ, Lin KM, Ternent CA, Thorson AG, Christensen MA. Use of preoperative ultrasound staging for treatment of rectal cancer. Dis Colon Rectum. 1999;42: 159–66.PubMedCrossRef
42.
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.PubMedCrossRef
43.
Akasu T, Sugihara K, Moriya Y, Fujita S. Limitations and pitfalls of transrectal ultrasonography for staging of rectal cancer. Dis Colon Rectum. 1997;40:S10–5.PubMedCrossRef
44.
AP Zbar. Endorectal ultrasonography in rectal cancer: a preliminary Barbadian experience. West Indian Med J. 2006;55:313–8.
45.
Vanagunas A, Lin DE, Stryker SJ. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol 99:109–12.
46.
Bali C, Nousias V, Fatouros M, Stefanou D, Kappas AM. Assessment of local stage in rectal cancer using endorectal ultrasonography (EUS). Tech Coloproctol. 2004;8:S170–3.PubMedCrossRef
47.
Bianchi P, Ceriani C, Palmisano A, Pompili G, Passoni GR, Rottoli M, et al. A prospective comparison of endorectal ultrasound and pelvic magnetic resonance in the preoperative staging of rectal cancer. Ann Ital Chir. 2006;77:41–6.PubMed
48.
Boyce GA, Sivak MV Jr, Lavery IC, Fazio VW, Church JM, Milsom J, et al. Endoscopic ultrasound in the pre-operative staging of rectal carcinoma. Gastrointest Endosc. 1992;38:468–71.PubMedCrossRef
49.
Giovannini M, Bories E, Pesenti C, Moutardier V, Moutardier V, Lelong B, Delpéro JR. Three-dimensional endorectal ultrasound using a new freehand software program: results in 35 patients with rectal cancer. Endoscopy. 2006;38:339–43.PubMedCrossRef
50.
Glaser F, Kuntz C, Schlag P, Herfarth C. Endorectal ultrasound for control of preoperative radiotherapy of rectal cancer. Ann Surg. 1993;217:64–71.PubMedCrossRef
51.
Gualdi GF, Casciani E, Guadalaxara A, d’Orta C, Polettini E, Pappalardo G. Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings. Dis Colon Rectum. 2000;43:338–45.PubMedCrossRef
52.
Herzog U, von FM, Tondelli P, Schuppisser JP. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum. 1993;36:127–34.PubMedCrossRef
53.
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.PubMed
54.
Kaneko K, Boku N, Hosokawa K, Ohtsu A, Fujii T, Koba I, et al. Diagnostic utility of endoscopic ultrasonography for preoperative rectal cancer staging estimation. Jpn J Clin Oncol. 1996;26:30–5.PubMed
55.
Kim JC, Kim HC, Yu CS, Han KR, Kim JR, Lee KH, et al. Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging. Am J Surg. 2006;192:89–97.PubMedCrossRef
56.
Mackay SG, Pager CK, Joseph D, Stewart PJ, Solomon MJ. Assessment of the accuracy of transrectal ultrasonography in anorectal neoplasia. Br J Surg. 2003;90:346–50.PubMedCrossRef
57.
Maor Y, Nadler M, Barshack I, Zmora O, Koller M, Kundel Y, et al. Endoscopic ultrasound staging of rectal cancer: diagnostic value before and following chemoradiation. J Gastroenterol Hepatol. 2006;21:454–8.PubMedCrossRef
58.
Massari M, De Simone M, Cioffi U, Gabrielli F, Boccasanta P, Bonavina L. Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma. Surg Laparosc Endosc. 1998;8:438–44.PubMedCrossRef
59.
Meyenberger C, Huch Boni RA, Bertschinger P, Zala GF, Klotz HP, Krestin GP. Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer. Endoscopy. 1995;27:469–79.PubMedCrossRef
60.
Nielsen MB, Qvitzau S, Pedersen JF, Christiansen J. Endosonography for preoperative staging of rectal tumours. Acta Radiol. 1996;37:799–803.PubMedCrossRef
61.
Pappalardo G, Reggio D, Frattaroli FM, Oddi A, Mascagni D, Urciuoli P, et al. The value of endoluminal ultrasonography and computed tomography in the staging of rectal cancer: a preliminary study. J Surg Oncol. 1990;43:219–22.PubMedCrossRef
62.
Norton SA, Thomas MG. Staging of rectosigmoid neoplasia with colonoscopic endoluminal ultrasonography. Br J Surg. 1999;86:942–6.PubMedCrossRef
63.
64.
Saitoh N, Okui K, Sarashina H, Suzuki M, Arai T, Nunomura M. Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination. Dis Colon Rectum. 1986;29:234–42.PubMedCrossRef
65.
Shami VM, Parmar KS, Waxman I. Clinical impact of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in the management of rectal carcinoma. Dis Colon Rectum. 2004;47:59–65.PubMedCrossRef
66.
Spinelli P, Schiavo M, Meroni E, Di Felice G, Andreola S, Gallino G, et al. Results of EUS in detecting perirectal lymph node metastases of rectal cancer: the pathologist makes the difference. Gastrointest Endosc. 1999;49:754–8.PubMedCrossRef
67.
Thaler W, Watzka S, Martin F, La Guardia G, Psenner K, Bonatti G, et al. Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging. Preliminary results of a prospective, comparative study. Dis Colon Rectum. 1994;37:1189–93.PubMedCrossRef
68.
Ramana KN, Murthy PV, Rao KP, Bhagawanulu, Mandapal T, Pratap B. Transrectal ultrasonography versus computed tomography in staging rectal carcinoma. Indian J Gastroenterol. 1997;16:142–3.PubMed
69.
Garcia-Aguilar J, Pollack J, Lee SH, Hernandez de Anda E, Mellgren A, Wong WD, et al. Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum. 2002;45:10–5.PubMedCrossRef
70.
Manger T, Stroh C. Accuracy of endorectal ultrasonography in the preoperative staging of rectal cancer. Tech Coloproctol. 2004;8:s14–5.PubMedCrossRef
71.
Kim JC, Yu CS, Jung HY, Kim HC, Kim SY, Park SK, et al. Source of errors in the evaluation of early rectal cancer by endoluminal ultrasonography. Dis Colon Rectum. 2001;44:1302–9.PubMedCrossRef
72.
Osti MF, Padovan FS, Pirolli C, Sbarbati S, Tombolini V, Meli C, et al. Comparison between transrectal ultrasonography and computed tomography with rectal inflation of gas in preoperative staging of lower rectal cancer. Eur Radiol. 1997;7:26–30.PubMedCrossRef
73.
Caseiro-Alves F, Goncalo M, Cruz L, Ilharco J, Leite J, Agostinho A, et al. Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound. Abdom Imaging. 1998;23:370–4.PubMedCrossRef
74.
Wiersema MJ, Vazquez-Sequeiros E, Wiersema LM. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiology. 2001;219:252–7.PubMed
75.
Vilmann P. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes. Gastrointest Endoscopy. 1996;43:S24–9.CrossRef
76.
Silvestri GA, Hoffman BJ, Bhutani MS, Hawes RH, Coppage L, Sanders-Cliette A, et al. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann Thorac Surg. 1996;61:1441–5; discussion 1445–6.
77.
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement, Lancet. 1999;354:1896–900.PubMedCrossRef
78.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, et al. Standards for Reporting of Diagnostic Accuracy Group. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. The Standards for Reporting of Diagnostic Accuracy Group. Croat Med J. 2003;44:635–8.PubMed
Metadaten
Titel
Accuracy of Endoscopic Ultrasound to Diagnose Nodal Invasion by Rectal Cancers: A Meta-Analysis and Systematic Review
verfasst von
Srinivas R. Puli, MD
Jyotsna B.K. Reddy
Matthew L. Bechtold
Abhishek Choudhary
Mainor R. Antillon
William R. Brugge
Publikationsdatum
01.05.2009
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 5/2009
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0337-4

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