title: How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review.
abstract: OBJECTIVE
  To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers.
  
  
  METHODS
  Only EUS studies confirmed by surgery were selected. 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. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing and allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 x 2 tables were constructed with the data extracted from each study. 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 DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights.
  
  
  RESULTS
  Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n=1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 had a pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was >0.10.
  
  
  CONCLUSIONS
  EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to have true anatomic stage of T4 disease.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Missouri-Columbia, One Hospital Drive, M580a, Columbia, Missouri 65212, United States.
authors.forename: Srinivas-Reddy
authors.initials: SR
authors.lastname: Puli
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Batapati Krishna Reddy
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
authors.forename: Mainor R
authors.initials: MR
authors.lastname: Antillon
authors.forename: Jamal A
authors.initials: JA
authors.lastname: Ibdah
mesh_terms: D019160:Endosonography; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*