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

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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.

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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

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Author information

Authors and Affiliations

  1. Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, 730000, China

    Ya Gao & Jinhui Tian

  2. Pathogens Biology Institute, School of Basic Medical Sciences, Lanzhou University, Lanzhou City, 730000, China

    Ya Gao & Gen Chen

  3. The Second Clinical Medical College of Lanzhou University, Lanzhou, 730000, China

    Jipin Li & Xueni Ma

  4. Gansu Provincial Hospital, Lanzhou, 73000, China

    Jiancheng Wang

  5. Department of Nursing, Rehabilitation Center Hospital of Gansu Province, Lanzhou, 730000, China

    Bo Wang

  6. Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China

    Jinhui Tian

  7. Basic Medical School, Guilin Medical University, Guangxi, 541004, China

    Gen Chen

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  1. Ya Gao
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  4. Jiancheng Wang
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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.

Corresponding authors

Correspondence to Jinhui Tian or Gen Chen.

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The authors declare that there is no conflict of interest.

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

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

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Gao, Y., Li, J., Ma, X. et al. The value of four imaging modalities in diagnosing lymph node involvement in rectal cancer: an overview and adjusted indirect comparison. Clin Exp Med 19, 225–234 (2019). https://doi.org/10.1007/s10238-019-00552-z

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  • DOI: https://doi.org/10.1007/s10238-019-00552-z

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