Endoscopic Ultrasound vs. Computed Tomography for Gastric Cancer Staging: A Network Meta-Analysis

Abstract

Gastric cancer preoperative staging is of outmost importance to assure proper management of the disease. Providing a relevant clinical stage relies on different imaging methods such as computed tomography (CT) or endoscopic ultrasound (EUS). We aimed to perform a network meta-analysis for gastric cancer clinical stage diagnostic tests, thus comparing the diagnostic accuracy of EUS vs. multidetector CT (MDCT) and EUS vs. EUS + MDCT. We plotted study estimates of pooled sensitivity and specificity on forest plots and summary receiver operating characteristic space to explore between-study variation in the performance of EUS, MDCT and EUS + MDCT for T1–T4, N0–N3, M0–M1 when data were available. Exploratory analyses were undertaken in RevMan 5. We included twelve studies with 2047 patients. Our results suggest that EUS was superior to MDCT in preoperative T1 and N staging. MDCT is more specific for the M stage but no significant difference in sensitivity was obtained. When comparing EUS vs. EUS + MDCT for T1 both sensitivity and specificity were not relevant. No significant differences were observed in T2–T4 stages. Even though EUS helped differentiate between the presence of invaded nodules, N stages should be carefully assessed by both methods since there is not sufficient data.

A novel DNA methylation signature associated with lymph node metastasis status in early gastric cancer

“…However, preoperative LNM identification is limited with current technologies. Endoscopic ultrasonography was reported with an accuracy of 43%, while CT imaging has an accuracy of 56% [ 31 , 32 ]. Clinicopathological features can be examined pathologically with endoscopically resected tissues (EMR or ESD) from EGC patients.…”

A potential decision-making algorithm based on endoscopic ultrasound for staging early gastric cancer: A retrospective study

“…EUS was used as a standard procedure in preoperative T staging of patients with gastric carcinomas. For GC, as EUS can visualize the different layers of the gastric wall as corresponding sonographic layers, it is generally considered an effective tool for T staging (12,13), especially in detailed staging--early (T1) vs advanced cancers; T1a vs T1b cancers (13)(14)(15)(16)(17). However, in previous studies, the accuracy rate of EUS ranged from 43% to more than 90% (14,18).…”

Updated Evaluation of the Diagnostic Performance of Double Contrast-Enhanced Ultrasonography in the Preoperative T Staging of Gastric Cancer: A Meta-Analysis and Systematic Review

“…Many imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), have been utilized clinically for evaluating the T stage of GC ( 5 , 6 ). Particularly, multi-detector row CT (MDCT) with multi-planar reformatted views is believed to be a powerful tool, but its sensitivity in T staging for early GC is low ( 7 ).…”