Diagnostic Efficacy of Different Imaging Modalities in Assessing Infiltration Depth of Superficial Esophageal Carcinoma: a Meta-analysis

doi:10.12114/j.issn.1007-9572.2025.0398

Abstract

Abstract:

Background

The depth of invasion in superficial esophageal carcinoma (SEC) is critically linked to treatment outcomes. However, there is currently no consensus on the optimal diagnostic approach for determining invasion depth in SEC.

Objective

To systematically evaluate the diagnostic performance of optical coherence tomography (OCT), magnifying endoscopy (ME), and endoscopic ultrasound (EUS) in identifying SEC limited to the epithelium or lamina propria mucosae (EP/LPM).

Methods

A comprehensive search was conducted for diagnostic studies on EP/LPM lesions of SEC using OCT, ME, and EUS in English databases including PubMed, Embase, Web of Science, Cochrane Library, and Chinese databases including CNKI, SinoMed, VIP, Wanfang Data. The retrieval period was set from database inception to October 2024. Two researchers independently screened studies, extracted data, and assessed the risk of bias. Meta-analysis was performed using Stata 16.0, RevMan 5.3, Meta-Disc 1.4, and R 4.4.0.

Results

A total of 21 diagnostic studies were included. The pooled sensitivity, specificity, and accuracy for diagnosing SEC EP/LPM lesions were as follows: OCT was 0.93(95%CI=0.89-0.96), 0.77(95%CI=0.54-0.91) and 0.87(95%CI=0.74-0.94), respectively; EUS was 0.73(95%CI=0.62-0.82), 0.82(95%CI=0.72-0.89) and 0.77(95%CI=0.72-0.81), respectively; ME was 0.86(95%CI=0.81-0.90), 0.75(95%CI=0.62-0.84) and 0.82(95%CI=0.78-0.85), respectively. The areas under the summary receiver operating characteristic curve for OCT, EUS, and ME were 0.92(95%CI=0.86-0.98), 0.83(95%CI=0.80-0.86) and 0.86(95%CI=0.85-0.88), respectively. The results of Deeks' funnel plot showed that the scatter points of OCT, EUS, and ME studies were symmetrically distributed on both sides of the regression line, indicating no publication bias (all P>0.05).

Conclusion

Both OCT and ME demonstrate high diagnostic sensitivity and accuracy for SEC EP/LPM lesions. Their overall diagnostic performance appears superior to that of EUS.

Key words: Superficial esophageal carcinoma, Optical coherence tomography, Endoscopic ultrasound, Magnifying endoscopy, Meta-analysis

摘要：

背景

浅表食管癌（SEC）浸润深度诊断与治疗预后息息相关，目前尚无关于SEC浸润深度诊断的最佳方法共识。

目的

系统评价光学相干断层扫描（OCT）、放大内镜（ME）以及超声内镜（EUS）诊断SEC黏膜上皮层/黏膜固有层（EP/LPM）病变的诊断效能。

方法

计算机检索PubMed、Embase、Web of Science、Cochrane Library等英文数据库以及中国知网（CNKI）、中国生物医学文献服务系统（SinoMed）、维普网（VIP）、万方数据知识服务平台（Wanfang Data）等中文数据库中关于OCT、ME以及EUS诊断SEC EP/LPM病变的研究文献，检索时限从建库至2024年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险，采用Stata 16.0、RevMan 5.3、Meta-Disc 1.4及R 4.4.0等软件进行Meta分析。

结果

共纳入21项诊断性试验，Meta分析结果显示，OCT、EUS和ME诊断SEC EP/LPM病变的灵敏度、特异度和准确度分别为OCT：0.93（95%CI=0.89~0.96）、0.77（95%CI=0.54~0.91）、0.87（95%CI=0.74~0.94），EUS：0.73（95%CI=0.62~0.82）、0.82（95%CI=0.72~0.89）、0.77（95%CI=0.72~0.81），ME：0.86（95%CI=0.81~0.90）、0.75（95%CI=0.62~0.84）、0.82（95%CI=0.78~0.85）；OCT、EUS和ME诊断SEC EP/LPM病变的受试者工作特征曲线下面积分别为0.92（95%CI=0.86~0.98）、0.83（95%CI=0.80~0.86）和0.86（95%CI=0.85~0.88）。Deeks漏斗图结果显示，OCT、EUS、ME研究散点对称性分布于回归线的两侧，说明无发表偏倚（P均>0.05）。

结论

OCT和ME在诊断SEC EP/LPM病变方面展现出较高的灵敏度与准确度，其综合诊断效能优于EUS。

关键词: 浅表食管癌, 光学相干断层扫描, 超声内镜, 放大内镜, Meta分析

LI Junjie,LIANG Junrong,LIU Zhenxiong, et al. Diagnostic Efficacy of Different Imaging Modalities in Assessing Infiltration Depth of Superficial Esophageal Carcinoma: a Meta-analysis[J]. Chinese General Practice, 2026, 29(35): 5290-5299. DOI: 10.12114/j.issn.1007-9572.2025.0398.
李俊杰,梁俊荣,刘震雄等. 不同成像方式对浅表食管癌浸润深度诊断效能的Meta分析[J]. 中国全科医学, 2026, 29(35): 5290-5299. DOI: 10.12114/j.issn.1007-9572.2025.0398.

Figures/Tables 9

References 35

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协变量	文献数量（篇）	灵敏度（95%CI）	Z值	P值	特异度（95%CI）	Z值	P值
探头类型			3.21	<0.01		1.22	0.22
环扫	1^[21]	0.41（0.21~0.60）			0.94（0.86~1.00）
微探头/径向	7^{[3,5,7,8,17,19,23]}	0.76（0.70~0.82）			0.79（0.71~0.87）
研究类型			0.15	0.58		0.62	0.53
前瞻性研究	2^[5,7]	0.74（0.55~0.93）			0.82（0.63~1.00）
回顾性研究	6^{[3,8,17,19,21,23]}	0.72（0.61~0.83）			0.83（0.73~0.92）
发表年份			0.19	0.85		3.29	<0.01
2020年前	4^[3,5,7,19]	0.78（0.68~0.89）			0.71（0.61~0.82）
2020年及以后	4^[8,17,21,23]	0.66（0.52~0.79）			0.89（0.84~0.94）
研究国家			1.08	0.28		0.31	0.25
日本	4^[3,5,7,17]	0.72（0.58~0.86）			0.82（0.69~0.94）
非日本	4^[8,19,21,23]	0.73（0.59~0.87）			0.84（0.71~0.96）
病变数量			1.00	0.50		0.97	0.33
<100个	2^[5,23]	0.73（0.52~0.93）			0.92（0.79-1.00）
≥100个	6^{[3,7,8,17,19,21]}	0.73（0.62~0.84）			0.81（0.71~0.91）

协变量	文献数量（篇）	灵敏度（95%CI）	Z值	P值	特异度（95%CI）	Z值	P值
探头类型			3.21	<0.01		1.22	0.22
环扫	1^[21]	0.41（0.21~0.60）			0.94（0.86~1.00）
微探头/径向	7^{[3,5,7,8,17,19,23]}	0.76（0.70~0.82）			0.79（0.71~0.87）
研究类型			0.15	0.58		0.62	0.53
前瞻性研究	2^[5,7]	0.74（0.55~0.93）			0.82（0.63~1.00）
回顾性研究	6^{[3,8,17,19,21,23]}	0.72（0.61~0.83）			0.83（0.73~0.92）
发表年份			0.19	0.85		3.29	<0.01
2020年前	4^[3,5,7,19]	0.78（0.68~0.89）			0.71（0.61~0.82）
2020年及以后	4^[8,17,21,23]	0.66（0.52~0.79）			0.89（0.84~0.94）
研究国家			1.08	0.28		0.31	0.25
日本	4^[3,5,7,17]	0.72（0.58~0.86）			0.82（0.69~0.94）
非日本	4^[8,19,21,23]	0.73（0.59~0.87）			0.84（0.71~0.96）
病变数量			1.00	0.50		0.97	0.33
<100个	2^[5,23]	0.73（0.52~0.93）			0.92（0.79-1.00）
≥100个	6^{[3,7,8,17,19,21]}	0.73（0.62~0.84）			0.81（0.71~0.91）

协变量	文献数量（篇）	灵敏度（95%CI）	Z值	P值	特异度（95%CI）	Z值	P值
增强方式			1.88	0.06		0.34	0.73
BLI	5^{[10,12,14,16,22]}	0.87（0.77~0.96）			0.77（0.57~0.97）
NBI	12^{[3,4,8,9,11,13,15,17,18,19,20,21]}	0.86（0.80~0.91）			0.74（0.62~0.87）
放大分型			2.58	<0.01		0.81	0.42
JES	14^{[3,4,8,9,11,13,14,15,16,17,18,19,20,22]}	0.85（0.79~0.90）			0.78（0.68~0.88）
Arima/Inoue	3^[10,13,21]	0.90（0.83~0.98）			0.58（0.29~0.87）
参与单位			1.26	0.21		1.28	0.20
单中心	14^{[3,4,8,9,13,14,15,16,17,18,19,20,21,22]}	0.86（0.81~0.91）			0.72（0.60~0.84）
多中心	3^[10,11,12]	0.86（0.73~0.99）			0.86（0.69~1.00）
研究类型			1.88	0.06		2.58	<0.01
前瞻性研究	6^{[9,10,12,13,14,16]}	0.90（0.85~0.95）			0.60（0.43~0.78）
回顾性研究	11^{[3,4,8,11,15,17,18,19,20,21,22]}	0.83（0.76~0.90）			0.83（0.73~0.92）
发表年份			1.75	0.08		0.52	0.62
2020年前	10^{[3,4,9,10,11,12,13,14,15,19]}	0.89（0.84~0.94）			0.76（0.63~0.90）
2020年及以后	7^{[8,16,17,18,20,21,22]}	0.81（0.72~0.89）			0.73（0.55~0.90）
研究国家			1.75	0.08		2.58	<0.01
日本	8^{[3,4,10,12,13,15,16,17]}	0.89（0.84~0.94）			0.63（0.48~0.79）
非日本	9^{[8,9,11,14,18,19,20,21,22]}	0.82（0.73~0.90）			0.86（0.76~0.96）
病变数量			3.29	<0.01		0.05	0.96
<100个	5^{[9,10,11,14,16]}	0.78（0.66~0.90）			0.81（0.65~0.98）
≥100个	12^{[3,4,8,12,13,15,17,18,19,20,21,22]}	0.88（0.84~0.93）			0.72（0.59~0.85）

协变量	文献数量（篇）	灵敏度（95%CI）	Z值	P值	特异度（95%CI）	Z值	P值
增强方式			1.88	0.06		0.34	0.73
BLI	5^{[10,12,14,16,22]}	0.87（0.77~0.96）			0.77（0.57~0.97）
NBI	12^{[3,4,8,9,11,13,15,17,18,19,20,21]}	0.86（0.80~0.91）			0.74（0.62~0.87）
放大分型			2.58	<0.01		0.81	0.42
JES	14^{[3,4,8,9,11,13,14,15,16,17,18,19,20,22]}	0.85（0.79~0.90）			0.78（0.68~0.88）
Arima/Inoue	3^[10,13,21]	0.90（0.83~0.98）			0.58（0.29~0.87）
参与单位			1.26	0.21		1.28	0.20
单中心	14^{[3,4,8,9,13,14,15,16,17,18,19,20,21,22]}	0.86（0.81~0.91）			0.72（0.60~0.84）
多中心	3^[10,11,12]	0.86（0.73~0.99）			0.86（0.69~1.00）
研究类型			1.88	0.06		2.58	<0.01
前瞻性研究	6^{[9,10,12,13,14,16]}	0.90（0.85~0.95）			0.60（0.43~0.78）
回顾性研究	11^{[3,4,8,11,15,17,18,19,20,21,22]}	0.83（0.76~0.90）			0.83（0.73~0.92）
发表年份			1.75	0.08		0.52	0.62
2020年前	10^{[3,4,9,10,11,12,13,14,15,19]}	0.89（0.84~0.94）			0.76（0.63~0.90）
2020年及以后	7^{[8,16,17,18,20,21,22]}	0.81（0.72~0.89）			0.73（0.55~0.90）
研究国家			1.75	0.08		2.58	<0.01
日本	8^{[3,4,10,12,13,15,16,17]}	0.89（0.84~0.94）			0.63（0.48~0.79）
非日本	9^{[8,9,11,14,18,19,20,21,22]}	0.82（0.73~0.90）			0.86（0.76~0.96）
病变数量			3.29	<0.01		0.05	0.96
<100个	5^{[9,10,11,14,16]}	0.78（0.66~0.90）			0.81（0.65~0.98）
≥100个	12^{[3,4,8,12,13,15,17,18,19,20,21,22]}	0.88（0.84~0.93）			0.72（0.59~0.85）