How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

Puli, Srinivas R.; Reddy, Jyotsna Batapati Krishna; Bechtold, Matthew L.; Antillon, Mainor R.; Ibdah, Jamal A.

doi:10.3748/wjg.14.4011

Cited by 122 publications

(126 citation statements)

References 47 publications

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“…The ability of ultrasound to image the GI wall has made ES the most accurate imaging modality for T staging of esophageal, gastric and rectal cancer [17][18][19]. Numerous clinical studies have shown that EUS is approximately 90% accurate in the T staging of GI cancers.…”

Section: Clinical Applications Of Gi Ultrasound Imagingmentioning

confidence: 99%

High-frequency ultrasonographic imaging of the gastrointestinal wall

Ødegaard

Nesje

Lærum

et al. 2012

Expert Review of Medical Devices

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Section: Clinical Applications Of Gi Ultrasound Imagingmentioning

confidence: 99%

High-frequency ultrasonographic imaging of the gastrointestinal wall

Ødegaard

Nesje

Lærum

et al. 2012

Expert Review of Medical Devices

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“…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]. EUS allows evaluation of the individual layers of the gastric wall, as well as the identification of enlarged regional lymph nodes and metastasis in the liver; thus, it may be used to stage gastric cancer according to the TNM classification [1,8]. In particular, EUS is used to determine whether patients with early cancers are appropriate candidates for endoscopic mucosal resection [9].…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

“…The outcomes of patients with gastric cancer are determined by histopathologic factors, such as depth of invasion, nodal status, and distant metastases [1]. Optimal treatment of patients with gastric cancer depends on accurately staging the cancer, and is most commonly accomplished through computed tomography (CT).…”

Section: Introductionmentioning

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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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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“…Classically, the usefulness of endoscopic ultrasound in the loco-regional extension diagnosis of this neoplasia has been proven in multiple studies (3). Thus the diagnostic precision for stage T varies between 70 and 90% depending on the series and on what type of endoscopic ultrasound is used, ultrasound frequencies and the location of the tumor (cardia or rest of the stomach) (8)(9)(10)(11)(12) deep staging are observed in stage T2 (8-12) tumors diagnosed by endoscopic ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible to get high quality images of the gastric wall and anatomical perigastric structures by means of endoscopic ultrasonography, therefore, it is being used with high diagnostic yield in the loco-regional staging of the gastric cancer (3)(4)(5)(6). However, the importance that these have for everyday medical practice has been cause for debate.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

Repiso

Gómez-Rodríguez

López-Pardo

et al. 2010

Rev. esp. enferm. dig.

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Objectives: to evaluate the diagnostic yield of endoscopic ultrasonography in loco-regional staging of gastric cancer in our medium and to determine the impact of this technique on later therapeutic management.Material and methods: this is a retrospective study carried out on patients histologically diagnosed with gastric adenocarcinoma who had been referred for endoscopic ultrasonographic examination. The technique results were compared with those obtained from surgical samples and/or from exploratory laparoscopylaparotomy. We compared the initial therapeutic decision based on conventional diagnostic techniques with the final therapeutic management based on the endoscopic ultrasonography results.Results: forty-six patients with gastric adenocarcinoma were included in the study (a reference exploration was available in 36 cases). Diagnostic precision was 70% in stage T, while in stages T1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. The sensitivity and specificity to differentiate T1-2 from T3-4 was 94 and 85%, respectively. We could not identify factors associated with obtaining a correct diagnosis in staging T. Diagnostic precision was 72% for stage N (N0: 58%; Nx 88%). The presence of free perigastric fluid was identified in 7 cases; the presence of peritoneal carcinomatosis was later confirmed in 5 of these. The result of endoscopic ultrasonography led to a modification in the subsequent therapeutic management in 13 patients (28%).Conclusions: endoscopic ultrasonography is a useful technique for loco-regional staging of gastric adenocarcinoma, which may have important implications in the therapeutic management of these patients.Key words: Gastric cancer. Endoscopic ultrasonography. Treatment. RESUMENObjetivos: valorar la rentabilidad diagnóstica de la ecoendoscopia en la estadificación locorregional del cáncer gástrico en nuestro medio y determinar el impacto de la técnica sobre el manejo terapéutico posterior.Material y métodos: estudio retrospectivo realizado en pacientes diagnosticados histológicamente de adenocarcinoma gástri-co que habían sido remitidos para la realización de ecoendoscopia. Se comparó el resultado de la técnica con el estudio final obtenido en la pieza operatoria y/o laparoscopia-laparotomía exploradora. Se comparó la decisión terapéutica inicial basada en los resultados de las técnicas diagnósticas convencionales, con el manejo terapéu-tico final basado en el resultado de la ecoendoscopia.Resultados: se incluyeron en el estudio 46 pacientes con adenocarcinoma gástrico (en 36 de los cuales se disponía de exploración de referencia). La precisión diagnóstica fue del 70% para el estadIo T, y para T1, T2, T3 y T4 del 100, 38, 82 y 100%, respectivamente. La sensibilidad y especificidad para diferenciar el estadio T1-2 del T3-4 fue del 94 y 85% respectivamente. No se identificaron factores relacionados con la obtención de un diagnóstico correcto en la estadificación T. La precisión diagnóstica fue del 72% para el estadio N (N0: 58%; Nx 88%). En 7 pacientes se identificó la pr...

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How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

Abstract: EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to have true anatomic stage of T4 disease.

Cited by 122 publications

References 47 publications

High-frequency ultrasonographic imaging of the gastrointestinal wall

High-frequency ultrasonographic imaging of the gastrointestinal wall

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

Usefulness of endoscopic ultrasonography in preoperative gastric cancer staging: diagnostic yield and therapeutic impact

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