Clinical Research
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 7, 2008; 14(25): 4011-4019
Published online Jul 7, 2008. doi: 10.3748/wjg.14.4011
How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review
Srinivas Reddy Puli, Jyotsna Batapati Krishna Reddy, Matthew L Bechtold, Mainor R Antillon, Jamal A Ibdah
Srinivas Reddy Puli, Jyotsna Batapati Krishna Reddy, Matthew L Bechtold, Mainor R Antillon, Jamal A Ibdah, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, Missouri 65212, United States
Author contributions: Puli SR designed the research; Puli SR and Batapati krishna Reddy J collected the data; Puli SR contributed analytic tools, analyzed data and wrote the paper; Puli SR, Batapati Krishna Reddy J, Bechtold ML, Antillon MR, and Ibdah JA helped edit the paper.
Correspondence to: Jamal A Ibdah, MD, PhD, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, One Hospital Drive, M580a, Columbia, Missouri 65212, United States. ibdahj@health.missouri.edu
Telephone: +1-573-8820482
Fax: +1-573-8844595
Received: September 11, 2007
Revised: January 25, 2008
Accepted: February 2, 2008
Published online: July 7, 2008
Abstract

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers.

METHODS: Only EUS studies confirmed by surgery were selected. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 × 2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights.

RESULTS: Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n = 1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 had a pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10.

CONCLUSION: 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.

Keywords: Gastric cancer; Staging; Meta-analysis; Endoscopic ultrasound