Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review

Ann Surg Oncol. 2009 May;16(5):1255-65. doi: 10.1245/s10434-009-0337-4. Epub 2009 Feb 14.


Background: Nodal staging in patients with rectal cancer predicts prognosis and directs therapy. Published data on the accuracy of endoscopic ultrasound (EUS) for diagnosing nodal invasion in patients with rectal cancer has been inconsistent.

Aim: To evaluate the accuracy of EUS in diagnosing nodal metastasis of rectal cancers.

Method: Study Selection Criteria: Only EUS studies confirmed by surgical histology were selected. Data Collection and Extraction: Articles were searched in Medline, Pubmed, and CENTRAL.

Statistical method: Pooling was conducted by both fixed-effects model and random-effects model.

Results: The initial search identified 3610 reference articles in which 352 relevant articles were selected and reviewed. Data were extracted from 35 studies (N = 2732) that met the inclusion criteria. Pooled sensitivity of EUS in diagnosing nodal involvement by rectal cancers was 73.2% (95% confidence interval [95% CI] 70.6-75.6). EUS had a pooled specificity of 75.8% (95% CI 73.5-78.0). The positive likelihood ratio of EUS was 2.84 (95% CI 2.16-3.72), and negative likelihood ratio was 0.42 (95% CI 0.33-0.52). All the pooled estimates, calculated by fixed- and random-effect models, were similar. SROC curves showed an area under the curve of 0.79. The P for chi-squared heterogeneity for all the pooled accuracy estimates was >.10.

Conclusions: EUS is an important and accurate diagnostic tool for evaluating nodal metastasis of rectal cancers. This meta-analysis shows that the sensitivity and specificity of EUS is moderate. Further refinement in EUS technologies and diagnostic criteria are needed to improve the diagnostic accuracy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Endosonography*
  • Humans
  • Lymph Nodes / diagnostic imaging*
  • Lymph Nodes / pathology
  • Lymphatic Metastasis
  • Neoplasm Staging
  • Rectal Neoplasms / diagnostic imaging*
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / secondary
  • Sensitivity and Specificity