TY - JOUR
T1 - Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers
T2 - a meta-analysis and systematic review{A figure is presented}
AU - Puli, Srinivas R.
AU - Singh, Shailender
AU - Hagedorn, Curt H.
AU - Reddy, Jyotsna
AU - Olyaee, Mojtaba
PY - 2007/5
Y1 - 2007/5
N2 - Background: Vascular invasion (VI) in a patient with pancreatic or periampullary cancers precludes surgery and indicates a poor prognosis. Published data on the accuracy of EUS in diagnosing VI is varied. Objective: The aim of this meta-analysis was to evaluate the accuracy of EUS in diagnosing VI in patients with pancreatic and periampullary cancers. Design: Data from EUS studies were pooled according to the Mantel-Haenszel and DerSimonian Laird methods. Patients: EUS studies in which VI was confirmed by surgery or angiography were selected. Interventions: EUS. Main Outcome Measures: Pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of EUS. Results: Data were extracted from 29 studies (N = 1308) that met the inclusion criteria. The pooled sensitivity of EUS in diagnosing VI was 73% (95% CI, 68.8-76.9) and the pooled specificity was 90.2% (95% CI, 87.9-92.2). The positive likelihood ratio for diagnosing VI by EUS was 9.1 (95% CI, 4.6-17.9) and the negative likelihood ratio was 0.3 (95% CI, 0.2-0.5). Diagnostic odds ratio, the odds of having VI in positive as compared with negative EUS studies, was 40.1 (95% CI, 16.1-99.9). The P value for χ2 heterogeneity for all the pooled estimates was >.05. Conclusions: Although EUS is the best noninvasive test to diagnose VI in pancreatic and periampullary cancers, this meta-analysis showed that the specificity (90%) is high but the sensitivity (73%) is not as high as suggested. Further refinements in EUS technologies and interpretation may improve the sensitivity for detecting VI.
AB - Background: Vascular invasion (VI) in a patient with pancreatic or periampullary cancers precludes surgery and indicates a poor prognosis. Published data on the accuracy of EUS in diagnosing VI is varied. Objective: The aim of this meta-analysis was to evaluate the accuracy of EUS in diagnosing VI in patients with pancreatic and periampullary cancers. Design: Data from EUS studies were pooled according to the Mantel-Haenszel and DerSimonian Laird methods. Patients: EUS studies in which VI was confirmed by surgery or angiography were selected. Interventions: EUS. Main Outcome Measures: Pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of EUS. Results: Data were extracted from 29 studies (N = 1308) that met the inclusion criteria. The pooled sensitivity of EUS in diagnosing VI was 73% (95% CI, 68.8-76.9) and the pooled specificity was 90.2% (95% CI, 87.9-92.2). The positive likelihood ratio for diagnosing VI by EUS was 9.1 (95% CI, 4.6-17.9) and the negative likelihood ratio was 0.3 (95% CI, 0.2-0.5). Diagnostic odds ratio, the odds of having VI in positive as compared with negative EUS studies, was 40.1 (95% CI, 16.1-99.9). The P value for χ2 heterogeneity for all the pooled estimates was >.05. Conclusions: Although EUS is the best noninvasive test to diagnose VI in pancreatic and periampullary cancers, this meta-analysis showed that the specificity (90%) is high but the sensitivity (73%) is not as high as suggested. Further refinements in EUS technologies and interpretation may improve the sensitivity for detecting VI.
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U2 - 10.1016/j.gie.2006.08.028
DO - 10.1016/j.gie.2006.08.028
M3 - Article
C2 - 17350008
AN - SCOPUS:34247214628
VL - 65
SP - 788
EP - 797
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 6
ER -