超声内镜对食管早癌浸润深度诊断价值的Meta分析

Diagnostic value of endoscopic ultrasonography on invasive depth of early esophageal cancer： a meta-analysis

目的系统评价超声内镜对食管早癌浸润深度的诊断价值。方法运用计算机在Pubmed、万方、CNKI数据库中检索国内外有关超声内镜对早期食管癌浸润深度及Tla、Tlb分期的研究，经纳入标准及排除标准筛选后保留的文献纳入Meta分析，计算合并灵敏度、特异度、阳性似然比、阴性似然比及诊断优势，并绘制合并受试者工作特征曲线以计算曲线下面积。结果共20篇文献1336例病例纳入最终的Meta分析。超声内镜判断食管黏膜内癌T1m的合并敏感度、特异度、阳性似然比、阴性似然比分别是0．86（95％CI：0．83-0．88）、0．81（95％CI：0．78-0．85）、4．92（95％CI：3．02-8．00）、0．19（95％CI：0．14-0．27），诊断优势比为32．54（95％CI：15．52—68．25），合并受试者工作特征曲线下面积为0．923。超声内镜判断食管黏膜下癌T1sm的合并敏感度、特异度、阳性似然比、阴性似然比分另4是0．81（95％CI：0．78-0．85）、0．86（95％CI：0．83—0．88）、5，17（95％CI：3．66-7．32）、0．20（95％CI：0．13-0．33），诊断优势比为32．02（95％CI：15．31-66．99），合并受试者工作特征曲线下面积为0．922。结论超声内镜用于食管早癌诊断的临床应用价值较好，其判断早期食管癌Tim及T1sm期的灵敏度、特异度、受试者工作特征曲线下面积均较高。

Objective To evaluate the diagnostic value of endoscopic ultrasonography （EUS） on preoperative invasive depth of early esophageal cancer. Methods A systematic retrieval was performed in PubMed, CNKI and Wangfang databases. Studies on diagnosis of EUS on invasion depth or T1a/T1b stage of early esophageal cancer were retrieved, and related literatures were selected for recta-analysis based on inclusion criteria. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic advantage were calculated, and the receiver operating characteristic curve was drawn to calculate the area under the curve （AUC）. Results A total of 20 articles with 1 336 cases were included in the recta- analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and AUC of EUS for Tlm staging of early esophageal cancer were 0. 86 （95% CI： 0.83-0. 88） , 0.81（95%CI： 0.78-0.85）, 4.92（95%CI： 3.02-8.00）, 0. 19（95%CI： 0.14-0.27）, 32.54（95%CI： 15.52-68.25） and 0. 923, respectively. For Tlsm staging, these results were 0. 81 （95%CI： 0.78-0. 85）, 0. 86（95% CI： 0.83-0. 88）, 5.17 （95% CI： 3.66-7. 32）, 0. 20 （95% CI： 0.13-0. 33 ）, 32. 02 （ 95% CI： 15.31-66. 99 ） and 0. 922, respectively. Conclusion The diagnostic value of EUS is good for early esophageal cancer, and it has a relatively high sensitivity, specificity and AUC for the Tlm and Tlsm staging.