Colorectal cancer (CRC) continues to be a primary contributor to the global health burden, and early detection is vital for optimal outcomes. Standard detection techniques, including colonoscopy and fecal occult blood tests, have been confirmed effective yet their invasiveness and poor sensitivity are a limitation. MicroRNA (miRNA) are now recognized as stable non-invasive biomarkers with differential expression in cancerous tissues, but reports have been heterogeneous and studied under different settings. This study, completed based on PRISMA guidelines, was a systematic review of miRNA signature diagnostic accuracy to detect early CRC. Case-case control studies, cross-sectional, and cohort research published between 2014–2024 were identified through the Scopus, PubMed, and Cochrane databases. We extracted diagnostic metrics such as sensitivity and specificity while assessing bias with the ROBINS-e tool and the Newcastle-Ottawa Scale. Meta-analyses showed that miRNA panels have high diagnostic accuracy with a pooled sensitivity of 1.84 (95% CI: 1.48–2.19) and a pooled specificity of 1.43 (95% CI: 1.01–1.85). The accuracy of miRNA-139-3p was the highest among all panels. Meta-regression did not reveal any significant confounders, while publication bias was not detected. These results highlight the miRNA panels’ potential as non-invasive biomarkers in early CRC detection, providing a promising alternative to conventional screening methods, with miRNA-139-3p as the most diagnostically accurate biomarker.
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