title: EUS for the staging of gastric cancer: a meta-analysis.
abstract: BACKGROUND
  The role of EUS in the locoregional staging of gastric carcinoma is undefined.
  
  
  OBJECTIVE
  We aimed to comprehensively review and quantitatively summarize the available evidence on the staging performance of EUS.
  
  
  METHODS
  We systematically searched the MEDLINE, Cochrane, CANCERLIT, and EMBASE databases for relevant studies published until July 2010.
  
  
  METHODS
  Formal meta-analysis of diagnostic accuracy parameters was performed by using a bivariate random-effects model.
  
  
  METHODS
  Fifty-four studies enrolling 5601 patients with gastric cancer undergoing disease staging with EUS were eligible for the meta-analysis.
  
  
  METHODS
  EUS staging accuracy across eligible studies was measured by computing overall sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR).
  
  
  RESULTS
  EUS can differentiate T1-2 from T3-4 gastric cancer with high accuracy, with overall sensitivity, specificity, PLR, NLR, and DOR of 0.86 (95% CI, 0.81-0.90), 0.91 (95% CI, 0.89-0.93), 9.8 (95% CI, 7.5-12.8), 0.15 (95% CI, 0.11-0.21), and 65 (95% CI, 41-105), respectively. In contrast, the diagnostic performance of EUS for lymph node status is less reliable, with overall sensitivity, specificity, PLR, NLR, and DOR of 0.69 (95% CI, 0.63-0.74), 0.84 (95% CI, 0.81-0.88), 4.4 (95% CI, 3.6-5.4), 0.37 (95% CI, 0.32-0.44), and 12 (95% CI, 9-16), respectively. Results regarding single T categories (including T1 substages) and Bayesian nomograms to calculate posttest probabilities for any target condition prevalence are also provided.
  
  
  CONCLUSIONS
  Statistical heterogeneity was generally high; unfortunately, subgroup analysis did not identify a consistent source of the heterogeneity.
  
  
  CONCLUSIONS
  Our results support the use of EUS for the locoregional staging of gastric cancer, which can affect the therapeutic management of these patients. However, clinicians must be aware of the performance limits of this staging tool.
authors: Meta-Analysis Unit, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy. simone.mocellin@unipd.it
authors: Simone
authors: S
authors: Mocellin
authors: Alberto
authors: A
authors: Marchet
authors: Donato
authors: D
authors: Nitti
mesh_terms: D019160:Endosonography; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D009367:Neoplasm Staging; D016017:Odds Ratio; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*