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

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 15; no. Suppl 1; pp. 19 - 26
• Main Authors: Cardoso, Roberta, Coburn, Natalie, Seevaratnam, Rajini, Sutradhar, Rinku, Lourenco, Laercio Gomes, Mahar, Alyson, Law, Calvin, Yong, Elaine, Tinmouth, Jill
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-09-2012; Springer Nature B.V
• Subjects: Abdominal Surgery; Cancer Research; Endosonography - methods; Gastric cancer; Gastroenterology; Humans; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Preoperative Care - methods; Reproducibility of Results; Review Article; Sensitivity and Specificity; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgical Oncology; TNM staging; EUS; Preoperative diagnosis; Gastric cancer; Meta-analysis
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-011-0115-4

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. Meta-analysis 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.