Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2023; 29(30): 4685-4700
Published online Aug 14, 2023. doi: 10.3748/wjg.v29.i30.4685
Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia: A meta-analysis
Cong Chen, Ya-Lan Song, Zhen-Yu Wu, Jing Chen, Yao Zhang, Lei Chen
Cong Chen, Ya-Lan Song, Zhen-Yu Wu, Jing Chen, Lei Chen, Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
Yao Zhang, Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
Author contributions: Chen C and Chen L conceived and designed the study; Chen C and Song YL contributed to the literature search, study selection and drafted the manuscript; Chen C, Wu ZY, and Chen L extracted the data; Chen C and Chen J contributed to the quality assessment; Chen C, Song YL, and Zhang Y analyzed the data; Chen C, Wu ZY, and Chen J interpreted the data; Wu ZY edited the manuscript; Chen J revised the manuscript; Chen L and Zhang Y contributed to the critical revision; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Chen, MD, PhD, Professor, Institute of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Main Street, Xinqiao Street, Shapingba District, Chongqing 400038, China. chenlei_1977603@126.com
Received: May 5, 2023
Peer-review started: May 5, 2023
First decision: July 9, 2023
Revised: July 16, 2023
Accepted: July 27, 2023
Article in press: July 27, 2023
Published online: August 14, 2023
ARTICLE HIGHLIGHTS
Research background

Upper gastrointestinal neoplasia, mainly including esophageal cancer and gastric cancer, is a common cancer with high mortality. Accurate prediction of lymph node metastasis (LNM) is of great significance for guiding clinical treatment and improving the prognosis of patients. In recent years, endoscopic ultrasound (EUS) has become increasingly used in the diagnosis and treatment of gastrointestinal diseases, but its application in the detection of LNM remains limited.

Research motivation

Although previous studies have reported the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia, the relevant research conclusions were controversial, and the research results have varied widely. Therefore, we intend to further carry out this research through meta-analysis.

Research objectives

This study aimed to systematically search the literature and examine the diagnostic value of conventional EUS for LNM in upper gastrointestinal neoplasia by summarizing and analyzing the data.

Research methods

We conducted a comprehensive search and screening of the PubMed, EMBASE and Cochrane Library databases from January 1, 2000 to October 1, 2022. Then, relevant study data were extracted, and the quality of the included studies was assessed based on the Quality Assessment of Diagnostic Accuracy Studies tool. Afterward, a meta-analysis was performed using the statistical software Stata 14.0.

Research results

A total of 2986 patients in 22 studies were included. The results showed that the pooled sensitivity, specificity and area under the summary receiver operating characteristic curve of conventional EUS in the diagnosis of upper gastrointestinal neoplasia LNM were acceptable, which were 0.62 [95% confidence interval (CI): 0.50-0.73], 0.80 (95%CI: 0.73-0.86) and 0.80 (95%CI: 0.76-0.83), respectively. However, the pooled positive likelihood ratio and negative likelihood ratio were relatively poor, at 3.15 (95%CI: 2.46-4.03) and 0.47 (95%CI: 0.36-0.61), respectively. The pooled diagnostic score and diagnostic odds ratio were relatively small, at 1.90 (95%CI: 1.51-2.29) and 6.67 (95%CI: 4.52-9.84), respectively.

Research conclusions

Conventional EUS has certain clinical value and can assist in the detection of LNM in upper gastrointestinal neoplasia, but it cannot be used as a confirmatory or exclusionary test. More high-quality studies are needed to further verify the diagnostic value of EUS and determine the best diagnostic criteria.

Research perspectives

In the future, further clinical studies should be carried out to evaluate the diagnostic value of various EUS assistive technologies for LNM in upper gastrointestinal neoplasia and to evaluate the influence of neoadjuvant therapy on the diagnostic value of EUS for LNM in upper gastrointestinal neoplasia.