A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma

被引:241
作者
Kelly, S
Harris, KM
Berry, E
Hutton, J
Roderick, P
Cullingworth, J
Gathercole, L
Smith, MA
机构
[1] Univ Leeds, Ctr Med Imaging Res, Leeds, W Yorkshire, England
[2] Univ Leeds, Acad Unit Med Phys, Leeds, W Yorkshire, England
[3] Leeds Teaching Hosp NHS Trust, Dept Radiol, Leeds, W Yorkshire, England
[4] MEDTAP Int Inc, London, England
[5] Wessex Inst Hlth Res & Dev, Southampton, Hants, England
关键词
endoscopic ultrasound; gastro-oesophageal cancer; TNM staging; systematic literature review; meta-analysis;
D O I
10.1136/gut.49.4.534
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background-Endoscopic ultrasound (EUS) may be used for preoperative staging of gastro-oesophageal carcinoma but performance values given in the literature differ. Aims-To identify and synthesise findings from all articles on the performance of EUS in tumour, node, metastasis (TNM) staging of gastro-oesophageal carcinoma. Source-Published and unpublished English language literature, 1981-1996. Methods-Data on the staging performance of EUS were retrieved and evaluated. Summary receiver operator characteristic methodology was used for synthesis, and a summary estimate of performance, Q*, obtained. Multiple regression analysis was used to assess study validity and investigate reasons for differences in performance. Results-Twenty seven primary articles were assessed in detail. Thirteen supplied results for staging oesophageal cancer, 13 for gastric cancer, and four for cancers at the gastro-oesophageal junction. For gastric T staging, Q*=0.93 (95% confidence interval (CI) 0.91-0.95) and for oesophageal T staging, Q*=0.89 (95% CI 0.88-0.92). For gastro-oesophageal T staging, including cancers at the gastrooesophageal junction, Q*=0.91 (95% CI 0.89-0.93). Inclusion of cases with non-traversable stenosis was found to slightly reduce staging performance. For N staging, Q*=0.79 (95% CI 0.75-0.83). In articles that compared EUS directly with incremental computed tomography, EUS performed better. None of the variables assessed in the regression analysis was significant using a Bonferroni correction. Three variables (anatomical location, traversability, and blinding) showed strong relationships for future research and validation. Conclusions-EUS is highly effective for discrimination of stages T1 and T2 from stages T3 and T4 for primary gastrooesophageal carcinomas. The failure rate of EUS from non-traversability of a stenotic cancer may be a limitation in some patient groups.
引用
收藏
页码:534 / 539
页数:6
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