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Clinical and Experimental Medicine

, Volume 19, Issue 2, pp 225–234 | Cite as

The value of four imaging modalities in diagnosing lymph node involvement in rectal cancer: an overview and adjusted indirect comparison

  • Ya Gao
  • Jipin Li
  • Xueni Ma
  • Jiancheng Wang
  • Bo Wang
  • Jinhui TianEmail author
  • Gen ChenEmail author
Original Article
  • 107 Downloads

Abstract

Several systematic reviews have investigated the accuracy of imaging modalities for lymph node involvement of rectal cancer, but there are considerable differences in conclusions. This overview aimed to assess the methodological and reporting quality of systematic reviews that evaluated the diagnostic value of imaging modalities for lymph node involvement in patients with rectal cancer and to compare the diagnostic value of different modalities for lymph node involvement. The PubMed, EMBASE, Cochrane Library and Chinese Biomedicine Literature were searched to identify relevant systematic reviews. The methodological quality was assessed using the AMSTAR checklist, and the reporting quality was assessed using PRISMA-DTA checklist. The indirect comparison was conducted to compare the accuracy of different imaging modalities. Seven systematic reviews involving 353 primary studies were included. The median (Range) AMSTAR scores were 6.0 (4.0–9.0); the median (Range) PRISMA-DTA scores were 18.0 (11.0–23.0). Sensitivity of MRI [0.69 (95% CI 0.63, 0.77)] was significantly higher than that of ERUS [0.57 (95% CI 0.53, 0.62)]. Specificity of ERUS [0.80 (95% CI 0.77, 0.83)] was significantly higher than that of CT [0.72 (95% CI 0.67, 0.78)]. Positive likelihood ratio of EUS [3.04 (95% CI 2.75, 3.36)] was significantly higher than that of CT [2.21 (95% CI 1.69, 2.90)]. EUS had better diagnostic value than CT and ERUS in the diagnosis of lymph node involvement. Compared with CT and ERUS, MRI was more sensitive. EUS and MRI had comparable diagnostic accuracy, but no modality was proved to be particularly accurate.

Keywords

Rectal cancer Lymph node involvement Imaging modality Diagnostic accuracy Overview 

Abbreviations

SR

Systematic review

EUS

Endoscopic ultrasound

CT

Computed tomography

MRI

Magnetic resonance imaging

ERUS

Endorectal ultrasonography

SEN

Sensitivity

SPE

Specificity

DOR

Diagnostic odds ratio

PLR

Positive likelihood ratio

NLR

Negative likelihood ratio

CI

Confidence interval

AMSTAR

Assessment of multiple systematic reviews

PRISMA-DTA

Preferred reporting items for systematic reviews and meta-analysis diagnostic test accuracy

Notes

Author contributions

YG, JT, and GC planned and designed the study. YG and JL screened potential studies and extracted data from the included studies. XM, JW, and BW assessed the risk of bias and summarized the evidence. YG and JT performed the statistical analysis. YG and GC wrote the first draft. JT and GC revised the draft. All authors approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

Ethical approval and patient consent are not required since this is an overview based on published studies.

Informed consent

All analyses were based on previously published studies; thus, no informed consent is required.

Supplementary material

10238_2019_552_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)
10238_2019_552_MOESM2_ESM.xlsx (13 kb)
Supplementary material 2 (XLSX 13 kb)
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Supplementary material 3 (XLSX 11 kb)
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Supplementary material 4 (XLSX 11 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Evidence-Based Medicine Centre, School of Basic Medical SciencesLanzhou UniversityLanzhou CityChina
  2. 2.Pathogens Biology Institute, School of Basic Medical SciencesLanzhou UniversityLanzhou CityChina
  3. 3.The Second Clinical Medical College of Lanzhou UniversityLanzhouChina
  4. 4.Gansu Provincial HospitalLanzhouChina
  5. 5.Department of NursingRehabilitation Center Hospital of Gansu ProvinceLanzhouChina
  6. 6.Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu ProvinceLanzhouChina
  7. 7.Basic Medical SchoolGuilin Medical UniversityGuangxiChina

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