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Medline ® Abstract for Reference 20

of '超声内镜在外分泌胰腺癌分期中的应用'

20
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Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review.
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Puli SR, Singh S, Hagedorn CH, Reddy J, Olyaee M
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Gastrointest Endosc. 2007;65(6):788. Epub 2007 Mar 9.
 
BACKGROUND: Vascular invasion (VI) in a patient with pancreatic or periampullary cancers precludes surgery and indicates a poor prognosis. Published data on the accuracy of EUS in diagnosing VI is varied.
OBJECTIVE: The aim of this meta-analysis was to evaluate the accuracy of EUS in diagnosing VI in patients with pancreatic and periampullary cancers.
DESIGN: Data from EUS studies were pooled according to the Mantel-Haenszel and DerSimonian Laird methods.
PATIENTS: EUS studies in which VI was confirmed by surgery or angiography were selected.
INTERVENTIONS: EUS.
MAIN OUTCOME MEASURES: Pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of EUS.
RESULTS: Data were extracted from 29 studies (N = 1308) that met the inclusion criteria. The pooled sensitivity of EUS in diagnosing VI was 73% (95% CI, 68.8-76.9) and the pooled specificity was 90.2% (95% CI, 87.9-92.2). The positive likelihood ratio for diagnosing VI by EUS was 9.1 (95% CI, 4.6-17.9) and the negative likelihood ratio was 0.3 (95% CI, 0.2-0.5). Diagnostic odds ratio, the odds of having VI in positive as compared with negative EUS studies, was 40.1 (95% CI, 16.1-99.9). The P value for chi(2) heterogeneity for all the pooled estimates was>.05.
CONCLUSIONS: Although EUS is the best noninvasive test to diagnose VI in pancreatic and periampullary cancers, this meta-analysis showed that the specificity (90%) is high but the sensitivity (73%) is not as high as suggested. Further refinements in EUS technologies and interpretation may improve the sensitivity for detecting VI.
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Division of General and Geriatric Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA.
PMID