Diagnostic Test Accuracy of Cytosponge-Trefoil Factor 3 for Barrett Esophagus: A Systemic Review and Meta Analysis

Introduction: Barrett's esophagus (BE), characterized by the replacement of normal esophageal squamous epithelium with columnar metaplasia, poses a risk of progression to esophageal adenocarcinoma. Early detection is essential to prevent malignant transformation. The Cytosponge, a novel, minimally invasive cell collection device, has been proposed as a diagnostic tool for BE by identifying trefoil factor 3 (TFF3)-positive cells. This meta-analysis evaluates the diagnostic accuracy of the Cytosponge technique for detecting BE. Methods: A systematic literature search was performed using PubMed and Web of Science for studies published up to May 2024. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the QUADAS-2 tool. A bivariate random-effects model was used to estimate pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs). Summary receiver operating characteristic (SROC) curves were generated. Results: Six studies comprising 3438 participants were included. For detecting BE with circumferential length > 1 cm (C1), pooled sensitivity and specificity were 0.75 (95% CI: 0.70–0.79) and 0.88 (95% CI: 0.76–0.94), respectively, with an area under the SROC curve (AUC) of 0.80 (0.77–0.84). For any circumferential length of metaplasia, sensitivity and specificity were 0.81 (95% CI: 0.76–0.85) and 0.89 (95% CI: 0.82–0.93), with an AUC of 0.90 (0.87–0.92). Conclusion: The Cytosponge demonstrates high diagnostic accuracy for detecting BE, especially for any length of metaplasia. Further large-scale studies are warranted to validate its routine clinical use.