超声内镜对直肠癌术前TN分期准确性的Meta 分析

目的:系统评价超声内镜(EUS) 对直肠癌术前TN分期的准确性?方法:计算机检索CBM?CNKI?万方及维普中文数据库,检索年限均从建库到2013 年10月,全面收集国内有关超声内镜对直肠癌术前TN分期的相关研究,手工检索相关杂志?会议论文集?学位论文汇编等?根据Cochrane 系统评价方法筛选研究并提取数据,采用Meta-Disc1.4版软件进行Meta分析?结果:16 篇文献符合纳入标准入组本系统评价,包括759例直肠癌患者?采用固定效应模型和随机效应模型合并统计量?Meta分析结果显示:EUS 对直肠癌术前T1~T4期的诊断准确性均较高,其合并敏感度分别为87.0%?82.0%?87.0%和76.0%,合并特异度分别为98.0%?93.0%?88.0%和96.0%;EUS对N分期的诊断准确性亦较高,合并敏感度和特异度分别为76.0%和81.0%,但各指标总体准确性均低于T分期?结论:现有证据表明,EUS联合腹部CT对直肠癌术前TNM分期的诊断准确性较高,可作为临床术前诊断直肠癌的有效工具,它对指导临床选择合理的治疗方式具有重要意义?

Accuracy of endoscopic ultrasound in the preoperative TN staging for rectal cancer:A Meta-analysis

Objective:To evaluate the accuracy of endoscopic ultrasound ( EUS) in the preoperative TN staging for rectal cancer (RC). Methods:We searched CBM,CNKI,Wanfang and VIP databases from inception to Oct. 2013. Domestic articles related to the accuracy of EUS in the preoperative TN staging for RC were collected comprehensively. Related journals,conference proceedings,academic dissertations were also searched manually. Based on the principles and methods of Cochrane systematic reviews,data were searched,studied and extracted. Data analysis was conducted by Meta-Disc1.4 software. Results:Sixteen studies with 759 RC cases which met the inclusion criteria were included in this analysis. Pooling was conducted by both fixed and random effects models. Meta analysis showed that the accuracy of EUS in the preoperative T1-T4 staging for RC was high. Pooled sensitivity of EUS to diagnose T1-T4 staging were 87.0%,82.0%,87.0% and 76.0%,respectively. Pooled specificity of EUS to diagnose T1-T4 were 98.0%,93.0%,88.0% and 96.0%,respectively. The accuracy of EUS in the N staging was also high. To diagnose N staging,EUS had a pooled sensitivity of 76.0% and specificity of 81.0%. However,the accuracy of EUS in the preoperative T staging was superior than N staging. Conclusion:The results suggest that EUS combined with abdomen CT may be an effective tool for clinical preoperative diagnosis in TNM stage of RC,which plays an important role in clinical selection of surgical approach and treatment.