A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma

Kelly, Steven; Harris, Keith M.; Berry, Elizabeth; Hutton, John; Roderick, Peter; Cullingworth, J. Barry; Gathercole, Laura; Smith, Michael A.

doi:10.1136/gut.49.4.534

Cited by 338 publications

(214 citation statements)

References 41 publications

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“…There are few other published systematic reviews and meta-analyses assessing EUS performance for staging gastric cancer. An early systematic review by Kelly et al [5] evaluated 27 articles, published between 1981 and 1996, of which 13 evaluated gastric cancer, and found that EUS performed better for staging gastric carcinoma compared to carcinomas of the esophagus. As with the study by Kelly et al, we found that EUS performed better when staging tumor invasion than when staging nodal status.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

et al. 2012

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Background Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer. Methods Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 1 December 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Metaanalysis for the performance of EUS was analyzed by calculating agreement (Kappa statistic), and pooled estimates of accuracy, sensitivity, and specificity for all EUS examinations, using histopathology as the reference standard. Subgroup analyses were also performed. Results Twenty-two articles met our inclusion criteria and were included in the review. EUS pooled accuracy for T staging was 75% with a moderate Kappa (0.52). EUS was most accurate for T3 disease, followed by T4, T1, and T2. EUS pooled accuracy for N staging was 64%, sensitivity was 74%, and specificity was 80%. There was significant heterogeneity between the included studies. Subgroup analyses found that annual EUS volume was not associated with EUS T and N staging accuracy (P = 0.836, 0.99, respectively). Conclusion EUS is a moderately accurate technique that seems to describe advanced T stage (T3 and T4) better than N or less advanced T stage. Stratifying by EUS annual volume did not affect EUS performance in staging gastric cancer.

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Section: Discussionmentioning

confidence: 99%

“…Endoscopic ultrasound (EUS) was introduced into clinical practice in the early 1980s as a way to assess the extent of local tumor infiltration and local lymph node status [5][6][7]. The main advantage of EUS is the ability to place the transducer close to the lesion without interference of fat, bowel gas, or bone [6].…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

et al. 2012

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“…EUS has been used widely as a powerful means of assessing clinical T and N status, with some studies reporting that EUS is superior to CT for evaluating regional LN metastasis and a diagnostic accuracy for LN involvement of approximately 80% (37)(38)(39)(40). However, other studies found that EUS tended to overestimate LN involvement and that the EUS accuracy was operator-dependent due to the experience required to master the technique (21,41,42).…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

et al. 2010

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Abstract. Patients with deeply invading (T3-T4) oesophageal cancers usually receive chemoradiotherapy with or without surgery. However, the prognostic significance of pre-therapy and post-therapy lymph node (LN) status remains unclear. We studied 195 patients who received chemoradiotherapy for deeply invading oesophageal cancers (T3-4, N0-1, M0). Of these, 105 patients underwent surgery while 90 were treated by chemoradiotherapy alone. Of the 105 surgically treated patients, overall survival was significantly better in cN0 patients than in cN1 (3-year survival rate, 65.3 vs. 25.8%, P=0.0014). This difference was similarly observed in 90 patients who received chemoradiotherapy alone. Patient survival differed significantly among patients with no positive LN, 1 positive LN and 2-4 positive LN (3-year survival rate, 57.1 vs. 40.5 vs. 17.6%, P<0.0001). However, there was no significant difference in survival between patients with 2-4 positive LN and ≥5 positive LN. Multivariate analysis identified pre-therapy LN status and the number of involved LNs as the most important independent prognostic factors prior to histopathological tumour regression. In conclusion, pretherapy LN status and the number of post-therapy involved LNs equally affect survival of patients who receive neoadjuvant chemoradiotherapy. Control of systemic metastasis is required, based on pre-and post-therapy LN status.

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“…In addition, the inability of EUS to clearly distinguish between the adventitial and the subadventitial layer is another source of error in the differentiation of T2 tumors that deeply infiltrate into the subadventia and T3 carcinomas. [16][17][18] Our study has several limitations. Our data contains a narrow clinical spectrum of diseases, with patients who had T1 or T2 stage in 73%.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Endoscopic Ultrasonography in Esophageal Cancer: A Single Center Experience

Ryu¹,

Kim

Lee

et al. 2016

Korean J Helicobacter Up Gastrointest Res

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Background/Aims: Determining the depth of tumor invasion and the presence of regional lymph node metastasis is important in deciding therapeutic strategies. We aimed to evaluate the diagnostic accuracy of EUS in detecting the depth of tumor invasion and regional lymph node metastasis. Materials and Methods: A total of 141 consecutive patients underwent preoperative evaluation using EUS, CT, and PET CT

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A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma

Cited by 338 publications

References 41 publications

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer

Pre- and post-therapy nodal status equally affects survival of patients with oesophageal squamous cell carcinoma receiving preoperative chemoradiation

Diagnostic Accuracy of Endoscopic Ultrasonography in Esophageal Cancer: A Single Center Experience

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