Systematic review and meta-analysis of endoscopic ultrasonography in staging diagnosis of esophageal cancer after neoadjuvant radiotherapy and chemotherapy

BACKGROUND: Clinically, it is necessary to evaluate the overall situation of the tumor before treatment, understand the disease stage of the patient, and choose the most reasonable treatment plan. Therefore, it is necessary to seek an efficient and accurate staging diagnosis method. Endoscopic ultrasonography (EUS) is widely used in staging esophageal cancer, but its accuracy will be affected by the experience of endoscopic diagnosis physicians. METHODS: Computer retrieval PubMed, MEDLINE, EBSCO, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI). Relevant literatures published from the database establishment to January 2022 were searched using “Endoscopic ultrasound, esophageal cancer, neoadjuvant chemotherapy, diagnosis, tumor node metastasis” as the detection term. Quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of the included literatures, Q test and heterogeneity (I2) was adopted to evaluate the heterogeneity among various studies, and the sensitivity and specificity of EUS were calculated and compared in evaluating various stages of esophageal cancer. RESULTS: A total of 12 articles and 824 patients were included. 12 literatures on EUS in diagnosis of T staging were included for heterogeneity test, the combined sensitivity of T1–T4 stage was 0.16 (95% CI: 0.05–0.39), 0.34 (95% CI: 0.20–0.52), 0.78 (95% CI: 0.63–0.88), 0.16 (95% CI: 0.04–0.50). The combined specificity was 0.99 (95% CI: 0.94–1.00), 0.52 (95% CI: 0.36–0.68), 0.98 (95% CI: 0.95–0.99). According to the heterogeneity test of EUS n staging in 9 literatures, the combined sensitivities of N0-N1 stage was 0.62 (95% CI: 0.53–0.71) and 0.65 (95% CI: 0.58–0.72), combined specificities was 0.65 (95% CI: 0.58–0.71) and 0.63 (95% CI: 0.54–0.72). DISCUSSION: Based on the results, EUS is not a good diagnostic test for TNM staging.