Staging investigations for oesophageal cancer: a meta-analysis

E P M van Vliet, M H Heijenbrok-Kal, M G M Hunink, E J Kuipers, P D Siersema, E P M van Vliet, M H Heijenbrok-Kal, M G M Hunink, E J Kuipers, P D Siersema

Abstract

The aim of the study was to compare the diagnostic performance of endoscopic ultrasonography (EUS), computed tomography (CT), and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in staging of oesophageal cancer. PubMed was searched to identify English-language articles published before January 2006 and reporting on diagnostic performance of EUS, CT, and/or FDG-PET in oesophageal cancer patients. Articles were included if absolute numbers of true-positive, false-negative, false-positive, and true-negative test results were available or derivable for regional, celiac, and abdominal lymph node metastases and/or distant metastases. Sensitivities and specificities were pooled using a random effects model. Summary receiver operating characteristic analysis was performed to study potential effects of study and patient characteristics. Random effects pooled sensitivities of EUS, CT, and FDG-PET for regional lymph node metastases were 0.80 (95% confidence interval 0.75-0.84), 0.50 (0.41-0.60), and 0.57 (0.43-0.70), respectively, and specificities were 0.70 (0.65-0.75), 0.83 (0.77-0.89), and 0.85 (0.76-0.95), respectively. Diagnostic performance did not differ significantly across these tests. For detection of celiac lymph node metastases by EUS, sensitivity and specificity were 0.85 (0.72-0.99) and 0.96 (0.92-1.00), respectively. For abdominal lymph node metastases by CT, these values were 0.42 (0.29-0.54) and 0.93 (0.86-1.00), respectively. For distant metastases, sensitivity and specificity were 0.71 (0.62-0.79) and 0.93 (0.89-0.97) for FDG-PET and 0.52 (0.33-0.71) and 0.91 (0.86-0.96) for CT, respectively. Diagnostic performance of FDG-PET for distant metastases was significantly higher than that of CT, which was not significantly affected by study and patient characteristics. The results suggest that EUS, CT, and FDG-PET each play a distinctive role in the detection of metastases in oesophageal cancer patients. For the detection of regional lymph node metastases, EUS is most sensitive, whereas CT and FDG-PET are more specific tests. For the evaluation of distant metastases, FDG-PET has probably a higher sensitivity than CT. Its combined use could however be of clinical value, with FDG-PET detecting possible metastases and CT confirming or excluding their presence and precisely determining the location(s).

Figures

Figure 1
Figure 1
Funnel plot in which the number of patients included in studies on the use of EUS for the detection of regional lymph node metastases was plotted against the log of the diagnostic odds ratio (D).
Figure 2
Figure 2
Funnel plot in which the number of patients included in studies on the use of CT for the detection of regional lymph node metastases was plotted against the log of the diagnostic odds ratio (D).
Figure 3
Figure 3
Summary receiver operating characteristic curves for EUS, FDG-PET, and CT for detection of regional lymph node metastases. P=not significant.
Figure 4
Figure 4
Summary receiver operating characteristic curves for FDG-PET and CT for detection of distant metastases. P<0.03.

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