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 15th 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.
