Kwee Robert Michael, Kwee Thomas Christian
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Clin Oncol. 2007 May 20;25(15):2107-16. doi: 10.1200/JCO.2006.09.5224.
Endoscopic ultrasound (EUS) has been established as the diagnostic modality of choice in local (T) staging of gastric cancer. Multidetector row computed tomography (MDCT) and magnetic resonance imaging (MRI) are promising alternatives. The aim of this study was to systematically review the literature regarding the performance of each of these imaging modalities.
A systematic search for relevant studies was performed in the PubMed/MEDLINE and EMBASE databases. Two reviewers independently assessed the methodological quality of each study. Local staging performance of included studies was calculated.
Twenty-two EUS studies, five MDCT studies, one combined EUS and MDCT study, and three MRI studies met the inclusion criteria. The studies were of moderate methodological quality. Diagnostic accuracy of overall T staging for EUS, MDCT, and MRI varied between 65% to 92.1%, 77.1% to 88.9%, and 71.4% to 82.6%, respectively. Sensitivity for assessing serosal involvement for EUS, MDCT, and MRI varied between 77.8% to 100%, 82.8% to 100%, and 89.5% to 93.1%, respectively. Specificity for assessing serosal involvement for EUS, MDCT, and MRI varied between 67.9% to 100%, 80% to 96.8%, and 91.4% to 100%, respectively.
EUS, MDCT, and MRI achieve similar results in terms of diagnostic accuracy in T staging and in assessing serosal involvement. Most experience has been gained with EUS. Few MDCT studies and even fewer MRI studies are available. Thus, EUS remains the first-choice imaging modality in preoperative T staging of gastric cancer.
内镜超声（EUS）已被确立为胃癌局部（T）分期的首选诊断方式。多排螺旋计算机断层扫描（MDCT）和磁共振成像（MRI）是很有前景的替代方法。本研究的目的是系统回顾关于这些成像方式各自性能的文献。
在PubMed/MEDLINE和EMBASE数据库中对相关研究进行系统检索。两名评价者独立评估每项研究的方法学质量。计算纳入研究的局部分期性能。
22项EUS研究、5项MDCT研究、1项EUS与MDCT联合研究以及3项MRI研究符合纳入标准。这些研究的方法学质量中等。EUS、MDCT和MRI的总体T分期诊断准确性分别在65%至92.1%、77.1%至88.9%以及71.4%至82.6%之间。EUS、MDCT和MRI评估浆膜侵犯的敏感性分别在77.8%至100%、82.8%至100%以及89.5%至93.1%之间。EUS、MDCT和MRI评估浆膜侵犯的特异性分别在67.9%至100%、80%至96.8%以及91.4%至100%之间。
EUS、MDCT和MRI在T分期诊断准确性及评估浆膜侵犯方面取得了相似的结果。EUS积累的经验最多。MDCT研究较少，MRI研究更少。因此，EUS仍然是胃癌术前T分期的首选成像方式。
