Endoscopic Ultrasound VS. Computed Tomography for Gastric Cancer Staging: A Network Meta-Analysis

Aims We aimed to perform a network meta-analysis for gastric cancer clinical stage diagnostic tests, by comparing the diagnostic accuracy of EUS vs. multidetector CT (MDCT) and EUS vs. EUS+MDCT.

Methods We performed a thorough literature search for studies reporting the accuracy of EUS and MDCT scans before September 15^th 2020. We plotted study estimates of pooled sensitivity and specificity on forest plots and summary receiver operating characteristic space to explore between-study variation in the performance of EUS, MDCT and EUS+MDCT for all T, N, M stages when data were available, using a bivariate random-effects model and a Bayesian approach.

Results We included twelve studies with 1859 patients. The sensitivity value for EUS was significantly higher than for MDCT (p=0.04) after using a random-effects model for a high heterogeneity of the included studies (χ2=287.01, I²=98 %, p<0.0001). The AUC for EUS (0.903) was bigger than for MDCT (0.774) and the summary ROC curve for T1 invasion indicated a better diagnostic performance of EUS vs. MDCT. For the N0vsN1+ the sensitivity for EUS was significantly higher than for MDCT (p=0.02) while the specificity value for MDCT was significantly higher than for EUS (p=0.02). The M stage showed the specificity value for MDCT was significantly higher than for EUS (p<0.00001). EUS was superior to MDCT in preoperative T1 and N staging. When comparing EUS vs EUS+MDCT for T1 both sensitivity and specificity were not relevant. No significant differences were observed in T2-T4. EUS is more reliable in predicting the presence of lymph nodes with a sensitivity of 84 %, whereas MDCT showed 75 %.

Conclusions EUS for T1 stage which can make the difference from ESD to multimodal therapy in gastric cancer patients. Even though EUS helped differentiate between the presence of invaded nodules, N stages should be carefully assessed by both methods since there is no sufficient data.

Citation Ungureanu BS, Sacerdotianu VM, Turcu-Stiolica A et al. eP380 ENDOSCOPIC ULTRASOUND VS. COMPUTED TOMOGRAPHY FOR GASTRIC CANCER STAGING: A NETWORK META-ANALYSIS. Endoscopy 2021; 53: S220.