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

A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma
A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma
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SOURCE: Published and unpublished English language literature, 1981-1996.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 gastro-oesophageal 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 gastro-oesophageal carcinomas. The failure rate of EUS from non-traversability of a stenotic cancer may be a limitation in some patient groups.
endoscopic ultrasound, gastro-oesophageal cancer, tnm staging, systematic literature review, meta-analysis
0017-5749
534-539
Kelly, S.
d40522b8-1037-4711-823d-50015e04f238
Harris, K.M.
99c6bbb4-81ee-437d-aa49-02644ecdd155
Berry, E.
0e183161-9b42-440c-9e16-900f4a51c12f
Hutton, J.
347eb1f6-ca2b-41c7-8a2d-c5c7e54b38f3
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Cullingworth, J.
dd3ad6cc-b0f5-4775-aaa6-340732baeacf
Gathercole, L.
af76f8ea-fb1e-4290-a3d8-fac15b3df528
Smith, M.A.
6afc505d-b28e-4d19-bab6-c11c4e58194b
Kelly, S.
d40522b8-1037-4711-823d-50015e04f238
Harris, K.M.
99c6bbb4-81ee-437d-aa49-02644ecdd155
Berry, E.
0e183161-9b42-440c-9e16-900f4a51c12f
Hutton, J.
347eb1f6-ca2b-41c7-8a2d-c5c7e54b38f3
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Cullingworth, J.
dd3ad6cc-b0f5-4775-aaa6-340732baeacf
Gathercole, L.
af76f8ea-fb1e-4290-a3d8-fac15b3df528
Smith, M.A.
6afc505d-b28e-4d19-bab6-c11c4e58194b

Kelly, S., Harris, K.M., Berry, E., Hutton, J., Roderick, P., Cullingworth, J., Gathercole, L. and Smith, M.A. (2001) A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut, 49 (4), 534-539. (doi:10.1136/gut.49.4.534).

Record type: Article

Abstract

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 gastro-oesophageal 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 gastro-oesophageal carcinomas. The failure rate of EUS from non-traversability of a stenotic cancer may be a limitation in some patient groups.

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More information

Published date: 2001
Keywords: endoscopic ultrasound, gastro-oesophageal cancer, tnm staging, systematic literature review, meta-analysis

Identifiers

Local EPrints ID: 24355
URI: http://eprints.soton.ac.uk/id/eprint/24355
ISSN: 0017-5749
PURE UUID: 3da08faa-54c4-4c66-98fc-afadbf367c54
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 30 Mar 2006
Last modified: 23 Jul 2022 01:38

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Contributors

Author: S. Kelly
Author: K.M. Harris
Author: E. Berry
Author: J. Hutton
Author: P. Roderick ORCID iD
Author: J. Cullingworth
Author: L. Gathercole
Author: M.A. Smith

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