The Role of EUS in Staging of Gastric Cardiacancer: A MetaAnalysis and Systematic Review - Abstract
Background
Prognosis and treatment in patients with Gastric Cardia Cancers (GCC) depends on the TNM staging. The published data on accuracy of Endoscopic Ultrasound (EUS) for TNM staging in GCC patients has been variable
Aim
To evaluate the accuracy of EUS in TNM staging of GCC cancers.
Method
Study Selection Criteria: Only EUS studies with staged gastric cardia cancers thatwere eventually confirmed by surgery were selected. EUS criteria
used for T staging were: T1- the tumor invades the lamina propria or submucosa but does not invade the muscularispropria, T2- the tumor invades but does
not extend beyond the muscularispropria, T3- the tumor invades the periesophageal tissues but does not invade adjacent organs, and T4- the tumor invades
adjacent structures. EUS criteria used for nodal invasion were: larger than 1 cm, hypoechoic, and round instead of elliptical. Only studies from which a 2 X 2
table could be constructed for true positive, false negative, false positive and true negative values were included.
Data collection & extraction: 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 into an abstraction form. The differences were resolved by mutual agreement. 2 X 2 tables were constructed with the data extracted
from each study.
Statistical Method: 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 by the DerSimonian Laird method (random
effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights.
Results
Seven studies were chosen which met the inclusion criteria in this analysis.
Conclusion
EUS has excellent sensitivity and specificity in accurately diagnosing T stage in a patient with GCC. EUS performs better with advanced disease (T4) than
early disease (T1). Theexcellent sensitivity and specificity of EUS in evaluating N (nodal) stage of gastric cardia cancers also allows for accurate staging and
planning of therapy. EUS should be strongly considered for staging of GCC.