Critical appraisal:Dunbar KB, Spechler SJ 2012

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Critical Appraisal

Article being appraised

Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett's esophagus: a systematic review. Am J Gastroenterol 2012 Jun;107(6):850-62; quiz 863 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22488081.


Applicable clinical question

Key Facts

Study Design

systematic review — contains a variety of largely non randomised trials

Number of Patients:

524


Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: Pools data from 70 reports largely cohort studies, totoal of 1874 patients 524 of which have HGD only. All have had resection reports path outcomes, detailed breakdonw to m1/2/3 levels only available for 12 studies of 70.

Risk of bias assessment: systematic review

Studies included in the review
Was an adequate search strategy used?
Very thorough – included appropriate search terms and databases
Were the inclusion criteria appropriate and applied in an unbiased way?
Yes – pre-specified inclusion criteria applied independently by two people
Were the studies assessed for quality (relating to the minimisation of biases)?
No – quality assessment either not undertaken, inappropriate or not described
Were the characteristics and results of individual studies appropriately summarised?
Yes – summary descriptive tables of subjects, interventions, outcomes etc are provided and estimates of treatment effect displayed
The following questions are only relevant for systematic reviews that pooled data
Were the methods used for pooling the data appropriate?
Yes
If there was heterogeneity, were sources of heterogeneity explored?
No heterogeneity
Size of effect
1 Reason for decision: The confidence interval for lymph node rate small. They have analysed the data when included only largest report from repeat institutions and results not statistically different
Relevance of evidence
1 Additional comments: Data is relevant 0/524 cses with HGD having surgery had lymph nodes positive, 26/1350 T1a had positive lymph nodes
Result of appraisal

Jutta's tick icon.png Included




Completed by

Associate Professor Bernard Mark Smithers


Jutta's tick icon.png This appraisal has been completed.


Article
Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett's esophagus: a systematic review. Am J Gastroenterol 2012 Jun;107(6):850-62; quiz 863 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22488081.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

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