EUS for Esophageal Carcinoma Staging

Transcrição

A Systematic Review of the Validity
of Endoscopic Ultrassound for
Esophageal Carcinoma Staging
2nd presentation
Class 3: Ana Maria Reis, Ana Margarida Rodrigues, Ana
Raquel Marçôa, Ana Raquel Freitas, Ana Raquel Marques,
Ana Raquel Barreira, Ana Coelho, Ana Rita Linhas, Ana Rita
Maia, Ana Rita Dias, Luís Gomes, Miguel Castro.
Project Manager: Mário Dinis Ribeiro
Faculdade de Medicina da
Universidade do Porto
Disciplina de Introdução à Medicina
1

INTRODUCTION
Esophageal cancer is a devastating disease
that continues to have less than 10% 5-year
survival despite advances in multimodality
therapy. Esophageal cancer is the eighth most
common cancer in the world, yet our
understanding of this lethal disease is very
limited [1].
[1] Allan Pickens, MDª, Mark B.,
Orringer, MDª. Geographical
distribution and racial disparity
in esophageal cancer.2003,
76:S1367-S1369.
2
INTRODUCTION:
This disease can be diagnosticated by endoscopy
with biopsies.
Stage:
Computerized tomography scan (CT-scan)
Magnetic resonance (MRI)
Endoscopic ultrassound (EUS) [2].
[2]Kiran S. Parmar,MD,Joseph
B.Zwischenberger,MD,Angela
L. Reeves,CGRN and Irving
Wacman,MD 2002,73:916-21.
3

Endoscopic ultrasound (EUS) has a central
role in the initial staging of esophageal
cancer, most notably because of its accuracy
in determining depth of tumour invasion and
regional lymph node metastases [4].
[4]Charles J. Lightdale and
Ketan G. Kulkarni.Role of
Endoscopic Ultrasonography in
the Staging and Follow-Up of
Esophageal
Cancer.2005,23:4483-4489.
4
INTRODUCTION:
http://www.b5orlandgroover.com/articles/eus.htm
5
INTRODUCTION:
Curative attempts:
Surgery
Chemotherapy
Radiation
[2]Kiran S.Parmar,MD,Joseph B.
Zwischenberger,MD,Angela L.
Reeves,CGRN and Irving
Wacman,MD.Clinical Impact of
Endoscopic Ultrasound-Guided
Fine Needle Aspiration of Celiac
Axis Lymph Nodes (M1a
Disease) in Esophageal
Cancer.2002,73:916-21.
6
INTRODUCTION:
The esophageal cancer is usually treated
according to tumour stage as defined in the
TNM system developed by the American
Joint Commission on Cancer [5].


Stages: T1, T2, T3 and T4 [5].
[5]J. Vickers and D.
Alderson.Oesophageal cancer
staging using endoscopic
ultrasonography.1998,85,994998.
7
INTRODUCTION:

The aim of this study is to evaluate the
consistency and validity of EUS (versus
surgical specimens).
8

METHODS

Data Source

Quality Criteria

Data to be extracted
9
METHODS:


Data Source
Articles were searched using MEDLINE data
base and the following clinical QUERY.
106 ARTICLES FOUND

Application of exclusion and inclusion criteria;
reading of all abstracts by 2 reviewers. If they
disagreed, there would be a 3rd reviewer (an
expert).
10
METHODS:

Data Source



Articles that have at least one exclusion criteria were
excluded.
For exclusion would be necessary the agreement of
the 2 reviewers.
The article was only accepted if it respected all the
inclusion criteria.
35 ARTICLES INCLUDED

These articles were evaluated relatively to their
methodological quality.
8 ARTICLES INCLUDED
11
METHODS:

Data Source
12
METHODS:
 Quality
Criteria
After being selected, the articles had to be
evaluated relatively to their methodological
quality.
The assessment of the methodological quality
of each study was performed using a scale
ranged from 0 to 24 points according to the
following points:
Introduction (1)
Methods: participants (4);data
collection (4); test methods (5);
statistical methods (2).
Results: participants (3); test
results (2); estimates (2).
Check list
13
METHODS:

Data to be extracted
Endoscopic ultrasound
T1

Data were extracted
according to TN
classification for
endoscopic
ultrasound and
surgery.
T2
T3
T4
N0
N1
N2
T1
T2
T3
Surg
ery
T4
N0
N1
N2
Data were introduced in SPSS data base.
14

RESULTS

Methodological Evaluation
Articles
Methodolical Quality Evaluation
10
1
9
1
8
1
7
1
6
1
5
1
4
1
8
3
1
8
2
1
1
1
0
12
5
13
6
11
Introduction
Methods
Results
2
6
5
11
3
12
4
[0,5] – Medíocre
[6, 11] – Não Satisfaz
[12, 15] – Satisfaz
[16, 19] - Bom
[20, 23] – Muito Bom
[24] - Excelente
5
2
11
5
13
5
6
10
15
20
25
Scale
Legend:
1 – Ishaan Kalha et all. 2004
2 – Sónia J. Wakelin et all. 2001
3 – S. Natsugoe et all. 1996
4 – Bryce D. Beseth et all. 2000
5 – L. B. Nesje et all. 2000
6 – Enrique Vazquez-Sequeiros
et all. 2001
7 – T. Pham et all. 1997
8 – Jan Heidemann et all. 2000
9 – Ernesto Laterza et all. 1999
10 – Gregory Zuccaro et all.
1999
Graphic 1 Methodological Evaluation
15
RESULTS:
Extraction Data

Population
325
323
320
315
310
306
305
300
frequency of endoscopes
295
T
N
6
5
4
3
2
1
0
7,5 MHz
7,5 e 12 MHz
7,5; 12 e 20 MHz
16

RESULTS:

Extraction Data
number of observers
3,5
3
2,5
2
1,5
1
0,5
0
um

dois
quatro
Observers were all expertise
17
RESULTS:

Sensitivity and specificity
Graphic 2 T sensitivity
Graphic 3: T specificity
18
RESULTS:

Sensitivity and specificity
Graphic 4 N sensitivity
Graphic 5 N specificity
19
DISCUSSION:


EUS demonstrated to have a high sensitivity, but not
so high specificity in diagnosing T stage tumours.

Results for sensitivity and specificity in diagnosing N
stage tumours aren’t so homogeneous
20

LIMITS:

Not all the articles had classifications for both T’s and
N’s

Secondary data
Articles included that are not in the internet, FMUP
Library or IPO Library
Ecological Study


21
FLOWCHART
Start
Pubmed Search
(Mesh terms)
Articles found : 106
Revision of titles and
abstracts
Excluded by 2
reviewers
No
Yes
No
Included by 2
reviewers
71 excluded articles:
- cardia (n 10);
- articles not English,
Portuguese, French or
Spanish (n 7);
- case reports (n= 21);
- Other classification of
staging other than TNM
classification of malignant
tumours (n= 19).
NO
Included by a 3ª
reviewer
Yes
35 included
article
Yes
Read
complete
article
Quality
8 articles
included
Introduce data
in SPSS
End
Introduce
data in
Metadisk
22

QUERY:
(("Endosonography"[MeSH] AND "Esophageal Neoplasms"[MeSH] staging) NOT
cardia) AND (((((((((((("sensitivity and specificity"[All Fields]) OR "sensitivity and
specificity/standards"[All Fields]) OR "specificity"[All Fields]) OR "screening"[All
Fields]) OR "false positive"[All Fields]) OR "false negative"[All Fields]) OR
"accuracy"[All Fields]) OR (((("predictive value"[All Fields] OR "predictive value
of tests"[All Fields]) OR "predictive value of tests/standards"[All Fields]) OR
"predictive values"[All Fields]) OR "predictive values of tests"[All Fields])) OR
(("reference value"[All Fields] OR "reference values"[All Fields]) OR "reference
values/standards"[All Fields])) OR ((((((((((("roc"[All Fields] OR "roc analyses"[All
Fields]) OR "roc analysis"[All Fields]) OR "roc and"[All Fields]) OR "roc area"[All
Fields]) OR "roc auc"[All Fields]) OR "roc characteristics"[All Fields]) OR "roc
curve"[All Fields]) OR "roc curve method"[All Fields]) OR "roc curves"[All Fields])
OR "roc estimated"[All Fields]) OR "roc evaluation"[All Fields])) OR "likelihood
ratio"[All Fields]) AND notpubref [sb])).

LIMITS: title/abstract.
Devillé, Walter L. et al;BMC
Medical Research Methodology
2002, 2:9
23

EUS for Esophageal Carcinoma Staging

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