Diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia: A meta-analysis

Table 1 Characteristics of the included studies

Ref.	Country	Study design	Center	EUS scan type	EUS scan frequency (MHz)	EUS diagnostic criteria1	Gold standard	Tumor type	Age2 (yr)	Sample size (cases)	TP	FP	FN	TN
Jeong et al[24], 2018	Korea	Retrospective	1	Radial	12/20	Criteria 1	Postoperative pathology	Esophageal cancer	64	435	57	31	80	267
Shi et al[25], 2017	China	Retrospective	1	Radial	-	Criteria 2	Postoperative pathology	Esophageal cancer	59	86	28	5	8	45
Shan et al[26], 2015	China	Prospective	1	Radial	7.5	Criteria 1	Postoperative pathology	Esophageal cancer	≥ 44	94	11	5	23	55
Lee et al[27], 2014	Korea	Retrospective	1	Radial	7.5/12/20	Criteria 2	Postoperative pathology	Esophageal cancer	69	12	2	0	3	7
Meister et al[28], 2013	Germany	Retrospective	5	Radial	20	Criteria 1	Postoperative pathology	Esophageal cancer	≥ 34	93	39	12	12	30
Yen et al[29], 2012	China	Retrospective	1	Radial	12/20	Criteria 2	Postoperative pathology	Esophageal cancer	≥ 43	27	5	12	0	10
Pech et al[30], 2010	Germany	Retrospective	1	Radial	7.5-10	Criteria 1	Postoperative pathology	Esophageal cancer	64	179	48	29	20	82
Machlenkin et al[31], 2009	Israel	Retrospective	1	Radial	7.5-12	Criteria 1	Postoperative pathology	Esophageal cancer	≥ 28	13	2	0	2	9
Mennigen et al[32], 2008	Germany	Retrospective	1	-	7.5/15	Criteria 1	Postoperative pathology	Esophageal cancer	65	97	49	15	10	23
Shimpi et al[33], 2007	United States	Retrospective	1	Radial	20	Criteria 1	Postoperative pathology	Esophageal cancer	-	37	9	1	3	24
Shinkai et al[34], 2000	Japan	Retrospective	1	Radial	7.5/12/15/20	Criteria 1	Postoperative pathology	Esophageal cancer	≥ 42	102	41	20	13	28
Richards et al[35], 2000	United Kingdom	Retrospective	1	Radial	7.5/12	Criteria 1	Postoperative pathology	Esophageal cancer	≥ 35	69	19	9	23	18
Li et al[36], 2017	China	Retrospective	1	Radial	5/7.5/10/12	Criteria 2	Postoperative pathology	Gastric cancer	57	81	48	4	3	26
Serrano et al[37], 2016	United States	Retrospective	1	Radial	7.5/10	Criteria 2	Postoperative pathology	Gastric cancer	≥ 42	46	8	6	8	24
Spolverato et al[38], 2015	United States	Retrospective	7	-	-	Criteria 2	Postoperative pathology	Gastric cancer	-	144	34	12	36	62
Fairweather et al[39], 2015	United States	Retrospective	1	Radial	5-10	Criteria 2	Postoperative pathology	Gastric cancer	67	49	2	3	25	19
Feng et al[40], 2013	China	Retrospective	1	-	5/7.5/12/15/20	Criteria 2	Postoperative pathology	Gastric cancer	57	610	307	45	118	140
Kutup et al[41], 2012	Germany	Retrospective	1	Radial	7.5/10/12	Criteria 2	Postoperative pathology	Gastric cancer	61	123	64	18	17	24
Zheng et al[42], 2011	China	Retrospective	1	Radial	7.5/12	Criteria 2	Postoperative pathology	Gastric cancer	58	162	48	20	49	45
Bohle et al[43], 2011	Germany	Retrospective	1	Radial	5-20	Criteria 1	Postoperative pathology	Gastric cancer	63	62	30	5	9	18
Hwang et al[44], 2010	Korea	Retrospective	1	Radial	5/7.5/12/20	Criteria 2	Postoperative pathology	Gastric cancer	≥ 49	247	16	6	67	158
Bentrem et al[45], 2007	United States	Retrospective	1	-	7.5-12	Criteria 2	Postoperative pathology	Gastric cancer	-	218	81	39	27	71

¹Criteria 1 (hypoechoic, round, well-defined margin, diameter ≥ 10 mm), Criteria 2 (others).

²Mean age or youngest age.

EUS: Endoscopic ultrasound; TP: True positives; FP: False positives; FN: False negatives; TN: True negatives.

Table 2 Subgroup analysis of the diagnostic value of conventional endoscopic ultrasound for lymph node metastasis in upper gastrointestinal neoplasia

Subgroup		Studies	Sensitivity (95%CI)	Specificity (95%CI)	PLR (95%CI)	NLR (95%CI)	DS (95%CI)	DOR (95%CI)	AUC (95%CI)
	All studies	22	0.62 (0.50-0.73)	0.80 (0.73-0.86)	3.15 (2.46-4.03)	0.47 (0.36-0.61)	1.90 (1.51-2.29)	6.67 (4.52-9.84)	0.80 (0.76-0.83)
Tumor type	Esophageal cancer	12	0.64 (0.51-0.76)	0.81 (0.70-0.88)	3.33 (2.27-4.87)	0.44 (0.33-0.59)	2.02 (1.53-2.50)	7.52 (4.64-12.18)	0.79 (0.75-0.83)
	Gastric cancer	10	0.59 (0.38-0.76)	0.80 (0.71-0.87)	2.95 (2.09-4.17)	0.52 (0.34-0.79)	1.74 (1.09-2.40)	5.71 (2.96-10.99)	0.79 (0.75-0.82)
Study area	Eastern country	10	0.63 (0.42-0.80)	0.84 (0.72-0.91)	3.83 (2.46-5.95)	0.44 (0.28-0.71)	2.15 (1.48-2.83)	8.62 (4.38-16.94)	0.82 (0.79-0.85)
	Western country	12	0.61 (0.48-0.73)	0.76 (0.69-0.82)	2.57 (2.13-3.11)	0.51 (0.38-0.67)	1.62 (1.26-1.99)	5.07 (3.53-7.30)	0.77 (0.73-0.80)
Publication year	2010-2018	16	0.60 (0.44-0.74)	0.82 (0.75-0.88)	3.36 (2.58-4.38)	0.48 (0.35-0.68)	1.94 (1.47-2.41)	6.93 (4.34-11.08)	0.81 (0.77-0.84)
	2000-2009	6	0.70 (0.56-0.81)	0.75 (0.56-0.88)	2.79 (1.50-5.18)	0.41 (0.27-0.62)	1.93 (1.01-2.85)	6.87 (2.74-17.22)	0.78 (0.74-0.81)
Sample size	≥ 100 cases	9	0.60 (0.46-0.73)	0.78 (0.67-0.87)	2.79 (2.14-3.65)	0.51 (0.40-0.65)	1.71 (1.45-1.97)	5.52 (4.24-7.18)	0.76 (0.72-0.80)
	< 100 cases	13	0.65 (0.61-0.90)	0.83 (0.72-0.89)	3.80 (2.45-5.89)	0.42 (0.26-0.69)	2.20 (1.42-2.99)	9.04 (4.13-19.81)	0.83 (0.80-0.86)
EUS diagnostic criteria1	Criteria 1	10	0.62 (0.50-0.73)	0.79 (0.71-0.86)	3.04 (2.38-3.88)	0.47 (0.37-0.60)	1.86 (1.58-2.14)	6.43 (4.84-8.54)	0.78 (0.74-0.82)
	Criteria 2	12	0.61 (0.41-0.79)	0.81 (0.70-0.88)	3.17 (2.19-4.60)	0.48 (0.30-0.75)	1.89 (1.22-2.57)	6.63 (3.37-13.05)	0.80 (0.76-0.83)

¹Criteria 1 (hypoechoic, round, well-defined margin, diameter ≥ 10mm), Criteria 2 (others).

PLR: Positive likelihood ratio; NLR: Negative likelihood ratio; DS: Diagnostic score; DOR: Diagnostic odds ratio; AUC: Area under the curve.