Systematic review and meta-analysisEUS versus magnetic resonance imaging in staging rectal adenocarcinoma: a diagnostic test accuracy meta-analysis
Section snippets
Registration
The study protocol was registered (CRD42017069308) with the International Prospective Register of Systematic Reviews.
Study selection
Studies directly comparing the accuracy of EUS and MRI in staging rectal cancer with surgical pathology as the reference standard were included. No restrictions were placed on US frequency or type of EUS used or on the field strength or type of coil used for MRI.
Studies using nonendoscopic US, such as rigid endorectal sonography, were excluded. Studies with insufficient data,
Literature Search
Six of 2475 studies were included in the diagnostic test accuracy meta-analysis. Figure 1 depicts the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for the detail of study selection and Table 1 the characteristics of included studies. Quality of included studies and risk of bias using the QUADAS-2 tool are represented in Figure 2.
Comparison of EUS and MRI
In overall T staging, EUS was significantly superior with an AUC of .87 (95% CI, .83-.90) as compared with .82 (95% CI, .78-.86) for MRI
Discussion
To our knowledge, this is the first diagnostic test accuracy meta-analysis comparing EUS and MRI in staging rectal cancer as compared with surgical pathology as the reference standard, in a head-to-head comparison, using appropriate methodology by the Cochrane Collaboration.7 Although both EUS and MRI showed reasonable diagnostic accuracy, EUS significantly outperformed MRI in overall T staging of rectal cancer in head-to-head analysis. After adjusting for technology and removing studies that
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DISCLOSURE: Dr Yaghoobi: Speaker for Abbvie and Pendopharm, research grant from Medtronic, and research support for this study from an Internal Career Award, Department of Medicine, McMaster University. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 301.