Factors Affecting the Accuracy of Endoscopic Ultrasonography in the Diagnosis of Early Gastric Cancer Invasion Depth: A Meta-analysis

BACKGROUND: Endoscopic ultrasonography (EUS) is the first imaging modality for investigating the depth of invasion in early gastric cancer (EGC). However, there is presently no consensus on the accuracy of EUS in diagnosing the invasion depth of EGC. AIM: This study is aimed at systematically evaluating the accuracy of EUS in diagnosing the invasion depth of EGC and its affecting factors. METHODS: The literatures were identified by searching PubMed, SpringerLink, Cochrane Library, Web of Science, Nature, and Karger knowledge databases. Two researchers extracted the data from the literature and reconstructed these in 2 × 2 tables. The Meta-DiSc software was used to evaluate the overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic advantage ratio, and 95% confidence interval (CI). The SROC was drawn, and the area under the curve (AUC) was calculated to evaluate the diagnostic value. RESULTS: A total of 17 articles were selected, which included 4525 cases of lesions. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic dominance ratio, and 95% CI of EUS for diagnosing EGC was 0.87 (95% CI: 0.86-0.88), 0.67 (95% CI: 0.65-0.70), 2.90 (95% CI: 2.25-3.75), 0.17 (95% CI: 0.13-0.23), and 18.25 (95% CI: 12.61-26.39), respectively. The overall overstaging rate of mucosa/submucosa 1 (M/SM1) and SM by EUS was 13.31% and 32.8%, respectively, while the overall understaging rate of SM was 29.7%. The total misdiagnosis rates for EUS were as follows: 30.4% for lesions ≥ 2 cm and 20.9% for lesions < 2 cm, 27.7% for ulcerative lesions and 21.4% for nonulcerative lesions, and 22% for differentiated lesions and 26.9% for undifferentiated lesions. CONCLUSION: EUS has a moderate diagnostic value for the depth of invasion of EGC. The shape, size, and differentiation of lesions might be the main factors that affect the accuracy of EUS in diagnosing EGC.