Diagnostic accuracy of magnifying Image-enhanced endoscopy for predicting the invasion depth of superficial esophageal neoplasm: a meta-analysis

The aim of this study was to assess the accuracy of magnifying image-enhanced endoscopy (IEE) for predicting the invasion depth of superficial esophageal neoplasm (SEN).

We searched PubMed, Embase, the Cochrane Library. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds radio (DOR) with 95% confidence interval (CI) were calculated by bivariate mixed effect model, the summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated to comprehensively evaluate the diagnostic value of magnifying IEE for the invasion depth of SEN.

Twelve literatures were included. The combined effect size of magnifying IEE in the diagnosis of carcinoma in situ (Tis) or tumor infiltrating lamina propria mucosae (LPM) were: sensitivity: 0.88(95%CI 0.83-0.92), specificity: 0.85(95%CI 0.76-0.91), PLR: 5.8(95%CI 3.6-9.3), NLR: 0.14(95%CI 0.09-0.20), DOR: 42 (95%CI 23-76), AUC: 0.93(95%CI 0.91-0.95); The combined effect size of magnifying IEE in the diagnosis of tumor infiltrating muscularis mucosae (MM) or tumor infiltrating the upper third of the submucosal layer (SM1) were: sensitivity: 0.72(95%CI 0.63-0.80), specificity: 0.86(95%CI 0.79-0.90), PLR: 5.0(95%CI 3.5-7.2), NLR: 0.32(95%CI 0.24-0.44), DOR: 15(95%CI 9-26), AUC: 0.86(95%CI 0.83-0.89); The combined effect size of magnifying IEE in the diagnosis of tumor infiltrating the middle third of the submucosal layer (SM2) or deeper were: sensitivity: 0.52(95%CI 0.40-0.64), specificity: 0.99(95%CI 0.98-0.99), PLR: 37.0(95%CI 24.5-55.9), NLR: 0.49(95%CI 0.38-0.63), DOR: 76(95%CI 45-127), AUC: 0.98(95%CI 0.96-0.99).

Magnifying IEE shows good overall diagnostic performance for assessing the invasion depth of SEN, with excellent diagnostic efficacy for superficial lesions, while the diagnostic sensitivity for deep lesions is relatively low. It can provide helpful evidence for selecting appropriate clinical treatments.