Endorectal ultrasound with elastography for differentiating benign and malignant rectal tumors: a systematic review and meta-analysis.

Background: Timely and precise diagnosis of rectal tumors is pivotal for improving patient outcomes. Despite advances in imaging technologies, differentiating benign adenomas from early-stage rectal cancer remains a significant challenge. The aim of this study was to assess the effectiveness of endorectal ultrasound (ERUS) elastography in differentiating rectal adenomas from cancer.

Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of the PubMed, Embase, and Cochrane databases was performed to identify studies that used ERUS elastography to assess rectal adenomas and cancer. A random effects model was employed to pool the sensitivity, specificity, and diagnostic odds ratio (DOR) for ERUS elastography in the diagnosis of rectal tumors.

Results: Ten studies encompassing a total of 722 patients with rectal tumors were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and DOR of ERUS elastography for distinguishing benign from malignant rectal tumors were 93% (95% confidence intervals (CI), 88%-96%), 86% (95% CI, 78%-92%), 6.71 (95% CI, 4.14-10.86), 0.08 (95% CI, 0.05-0.14), and 84 (95% CI, 38-186), respectively. The summary receiver operating characteristic (SROC) curve demonstrated an area under the curve (AUC) of 0.95 (95% CI, 0.93-0.97).

Conclusion: ERUS elastography greatly enhances diagnostic precision by distinguishing rectal adenomas from cancer, providing an effective approach to differentiate benign from malignant rectal lesions.