The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

Abstract

Objective: To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Methods: Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. Results: 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. Conclusion:The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. Advances in knowledge:In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.Gastric carcinoma (GC) is the fourth most common cancer and the second leading cause of cancer-related death with a 5-year survival rate of ,20% around the world. 1 The disease is more common in Asian countries, especially China, Japan and Republic of Korea.2,3 Accurate assessment of local tumour depth invasion (T) and regional lymph node invasion (N) plays an essential role in predicting prognosis and determining the most appropriate treatment planning. 4,5The pre-operative staging of GC has been based on a multimodality approach, such as endoscopic ultrasonography (EUS), CT, MRI and positron emission tomography (PET).6,7 EUS and CT have been widely used for GC staging in previous years.8 Of course, different imaging modalities have themselves relative merits. CT with ionized radiation requires the injection of iodine contrast medium.9 EUS is an invasive technique requiring sedation 1 and is highly operator dependent.10 PET highly depends upon the standardized uptake value and the pathological subtype of the cancer. 11MRI is a powerful imaging method with high soft-tissue contrast, with technical versatility for sequence selection and modification, and without ionizing radiation. However, it was unsuitable for the staging of GC owing to its long acquisition time and susceptibility to motion artefacts in previous years. With technology improved and shorter imaging time, these limitations have recently been partially overcome. 12Recently, there has been much research using MRI to assess pre-operative staging of GC. Nevertheless, the number of patients in each study has been insufficient, and the results varied among the articles. Also, the limited imaging field of view of MRI in a single session makes it difficult to stage the distant metastasis (M). 13Therefore, the o...

DCE-MRI, DW-MRI, and MRS in Cancer

“…The evidence for the use of DW-MRI alone in cancer diagnosis is overwhelming with nearly 1000 publications and numerous meta-analyses in the last decade advocating its use in a variety of tumor types. 98–101 Diagnostic accuracies vary by disease site, but in most meta-analyses, sensitivity and specificity were greater than 80%, except for prostate cancer, wherein pooled sensitivity for DW-MRI in a meta-analysis of 21 studies was 62% 102 and in breast cancer wherein specificity at best is around 71%. 103 In both these tumor types, therefore, there has been a move to use a combination of parameters to improve diagnostic performance and an increasing body of data are accruing indicating the superiority of a multi- over a single parameter approach (Fig.…”

Preoperative staging of nodal status in gastric cancer

“…However, when compared to other standard techniques like CT or EUS, no benefit or even inferior results were seen regarding the accuracy of lymph node assessment (32,33). One recent comparative study and a recent meta-analysis concluded that MRI was a helpful technique in staging the T-category and had a poor detection rate for lymph node metastasis in gastric cancer (34,35). MRI, when used in a liver-specific protocol, is mostly used to clarify suspicious liver lesions if no biopsy is performed (16).…”

Positron Emission Tomography/Magnetic Resonance Imaging Practices in Oncological Imaging

“…Yayımlanan bir meta analizde MR görüntülemenin T1-2 ile T3-4 tümörlerin ayrımında yüksek tanısal doğruluk gösterdiği; nodal evrelemede ise duyarlılığı yüksek olsa da özgüllüğünün düşük olduğu gösterilmiştir (88). Özellikle difüzyon ağırlıklı görüntülemenin T evrelemesinin doğruluğunu artırdığı, Borrmann tip 4 ileri mide kanserinin yeterince şişirilmemiş normal mide duvarından ayrımına katkı sunduğu belirtilmektedir (86).…”