World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 4, Number 2, April 2013, pages 74-82

Diagnostic Accuracy of Imaging Modalities in the Evaluation of Vascular Invasion in Pancreatic Adenocarcinoma: A Meta-Analysis

Figure 1. Forest plots of sensitivity Pooled results for sensitivity of (a) CT, (b) EUS, and (c) MRI in detection of vascular invasion in pancreatic adenocarcinoma. The limits of the diamond represent the 95% confidence interval of the pooled estimate.

Figure 2. Forest Plots of specificity Pooled results for specificity of (a) CT, (b) EUS, and (c) MRI in detection of vascular invasion in pancreatic adenocarcinoma. The limits of the diamond represent the 95% confidence interval of the pooled estimate.

**Table 1.** Characteristics of Included Studies
	Year	Study design	Patients (n)	Mean age (years)	Males (%)	Modality
n: number of patients who had surgical staging; NS: not specified; P: prospective; R: retrospective.
Mertz [12]	2000	P	16	NS	NS	EUS
Ahmad [21]	2001	P	21	61	76	EUS
Arslan [22]	2001	R	31	63	48	CT, MRI
Tierney [13]	2001	P	24	64	57	CT, EUS
Lopez Hanninen [23]	2002	P	34	58	55	MRI
Procacci [24]	2002	R	63	64	59	CT
Valls [25]	2002	P	39	61	62	CT
Rivadeneira [26]	2003	R	44	62	58	CT, EUS
Yusoff [27]	2003	R	32	60	62	EUS
Ramsay [28]	2004	P	19	57	44	CT, EUS, MRI
Soriano [29]	2004	P	59	65	53	CT, EUS, MRI
Vargas [30]	2004	R	25	64	52	CT
Karmazanovsky [31]	2005	R	69	60	58	CT
Li [32]	2005	P	54	61	67	CT
Buchs [33]	2007	R	153	NS	49	CT, EUS
Zamboni [34]	2007	R	114	70	46	CT

Table 1. Characteristics of Included Studies

Year

Study design

Patients (n)

Mean age (years)

Males (%)

Modality

n: number of patients who had surgical staging; NS: not specified; P: prospective; R: retrospective.

Mertz [12]

2000

EUS

Ahmad [21]

2001

EUS

Arslan [22]

2001

CT, MRI

Tierney [13]

2001

CT, EUS

Lopez Hanninen [23]

2002

MRI

Procacci [24]

2002

Valls [25]

2002

Rivadeneira [26]

2003

CT, EUS

Yusoff [27]

2003

EUS

Ramsay [28]

2004

CT, EUS, MRI

Soriano [29]

2004

CT, EUS, MRI

Vargas [30]

2004

Karmazanovsky [31]

2005

Li [32]

2005

Buchs [33]

2007

153

CT, EUS

Zamboni [34]

2007

114

**Table 2.** Estimates of Diagnostic Accuracy
	No. Studies	Sensitivity (95% CI)	Specificity (95% CI)	LR+ (95% CI)	LR- (95% CI)	DOR (95% CI)	AUC (SE)	Q*
CI: confidence interval; LR+: positive likelihood ratio; LR-: negative likelihood ratio; DOR: diagnostic odds ratio; AUC: area under the curve; SE: standard error; Q*: Cochran’s Q point; the point on the SROC curve where sensitivity equals specificity.
CT	12	0.73 (0.67 - 0.79)	0.95 (0.93 - 0.97)	10.41 (5.50 - 19.70)	0.31 (0.21 - 0.48)	45.94 (17.98 - 117.40)	0.93 (0.04)	0.87
EUS	8	0.66 (0.56 - 0.75)	0.94 (0.85 - 0.97)	7.02 (3.78 - 13.06)	0.42 (0.29 - 0.61)	23.03 (9.37 - 56.61)	0.89 (0.05)	0.82
MRI	4	0.63 (0.48 - 0.77)	0.93 (0.86 - 0.98)	8.88 (2.74 - 28.79)	0.44 (0.30 - 0.63)	23.89 (5.43 - 105.09)	0.65 (0.21)	0.62

Table 2. Estimates of Diagnostic Accuracy

No. Studies

Sensitivity (95% CI)

Specificity (95% CI)

LR+ (95% CI)

LR- (95% CI)

DOR (95% CI)

AUC (SE)

CI: confidence interval; LR+: positive likelihood ratio; LR-: negative likelihood ratio; DOR: diagnostic odds ratio; AUC: area under the curve; SE: standard error; Q*: Cochran’s Q point; the point on the SROC curve where sensitivity equals specificity.

0.73 (0.67 - 0.79)

0.95 (0.93 - 0.97)

10.41 (5.50 - 19.70)

0.31 (0.21 - 0.48)

45.94 (17.98 - 117.40)

0.93 (0.04)

0.87

EUS

0.66 (0.56 - 0.75)

0.94 (0.85 - 0.97)

7.02 (3.78 - 13.06)

0.42 (0.29 - 0.61)

23.03 (9.37 - 56.61)

0.89 (0.05)

0.82

MRI

0.63 (0.48 - 0.77)

0.93 (0.86 - 0.98)

8.88 (2.74 - 28.79)

0.44 (0.30 - 0.63)

23.89 (5.43 - 105.09)

0.65 (0.21)

0.62

**Table 3.** Subgroup Analysis: Single Slice CT Compared to MDCT
	No. Studies	Sensitivity (95% CI*)	Specificity (95% CI)	DOR (95% CI)
CI: confidence interval; DOR: diagnostic odds ratio.
Single slice CT	9	0.70 (0.63 - 0.77)	0.94 (0.91 - 0.97)	32.21 (11.5 - 90.2)
MDCT	4	0.80 (0.70 - 0.89)	0.97 (0.93 - 1.00)	65.1 (9.89 - 428.88)

Table 3. Subgroup Analysis: Single Slice CT Compared to MDCT

No. Studies

Sensitivity (95% CI*)

Specificity (95% CI)

DOR (95% CI)

CI: confidence interval; DOR: diagnostic odds ratio.

Single slice CT

0.70 (0.63 - 0.77)

0.94 (0.91 - 0.97)

32.21 (11.5 - 90.2)

MDCT

0.80 (0.70 - 0.89)

0.97 (0.93 - 1.00)

65.1 (9.89 - 428.88)