Critical appraisal:Thosani N, Singh H, Kapadia A, Ochi N, Lee JH, Ajani J, et al 2012

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Critical Appraisal

Article being appraised

Thosani N, Singh H, Kapadia A, Ochi N, Lee JH, Ajani J, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc 2012 Feb;75(2):242-53 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22115605.


Applicable clinical question

Key Facts

Study Design

systematic review — The systematic review included both retrospective and prospective studies. The study designs of the 19 included studies was not specified in the article.

Number of Patients:

1019


Includes an economic evaluation

no

Evidence ratings

Level of evidence

IV


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)?
Yes – appropriate quality issues were assessed independently by two people
Were the characteristics and results of individual studies appropriately summarised?
Adequate – more information would be desirable
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?
Yes
Size of effect
2 Reason for decision: Please replace this text and briefly describe the reasons for your rating
Relevance of evidence
2 Additional comments: Please replace this text and briefly describe the reasons for your rating
Result of appraisal

Jutta's tick icon.png Included



Comments

This is a meta-analysis of 19 international diagnostic accuracy studies in which results of EUS-based staging of oesophageal cancer were compared with the results of histopathology of EMR or surgically resected oesophageal lesions. These studies included both SCC and adenocarcinoma but results included subgroup analysis of adenocarcinoma only. Overall, EUS accurately staged 143 of 170 lesions (84%) with adenocarcinoma. For adenocarcinoma, EUS understaged 12 of 170 (7%) and overstaged 15 of 170 lesions (9%) while evaluating for submucosal invasion. For Barrett’s
esophagus–related early adenocarcinoma for T1a and T1b staging, the AUC values were 0.94. The meta-analysis concluded that that EUS has overall good sensitivity and specificity in detecting mucosal or submucosal invasion in SEC and plays a critical role in detecting T2 lesions that are not amenable to EMR or ESD.

Completed by

Dr Jeremy Dwyer MBBS (Hons)


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


Article
Thosani N, Singh H, Kapadia A, Ochi N, Lee JH, Ajani J, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc 2012 Feb;75(2):242-53 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22115605.
Assigned to
User:Alan.moss
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

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