Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuang Yong Road, Nanning 530021, Guangxi, PR China.
BMC Gastroenterol. 2011 Mar 9;11:19. doi: 10.1186/1471-230X-11-19.
Hepatic and peritoneal metastases of gastric cancer are operation contraindications. Systematic review to provide an overview of imaging in predicting the status of liver and peritoneum pre-therapeutically is essential.
A systematic review of relevant literatures was performed in Pubmed/Medline, Embase, The Cochrane Library and the China Biological Medicine Databases. QUADAS was used for assessing the methodological quality of included studies and the bivariate model was used for this meta-analysis.
Totally 33 studies were included (8 US studies, 5 EUS studies, 22 CT studies, 2 MRI studies and 5 18F-FDG PET studies) and the methodological quality of included studies was moderate. The result of meta-analysis showed that CT is the most sensitive imaging method [0.74 (95% CI: 0.59-0.85)] with a high rate of specificity [0.99 (95% CI: 0.97-1.00)] in detecting hepatic metastasis, and EUS is the most sensitive imaging modality [0.34 (95% CI: 0.10-0.69) ] with a specificity of 0.96 (95% CI: 0.87-0.99) in detecting peritoneal metastasis. Only two eligible MRI studies were identified and the data were not combined. The two studies found that MRI had both high sensitivity and specificity in detecting liver metastasis.
US, EUS, CT and 18F-FDG PET did not obtain consistently high sensitivity and specificity in assessing liver and peritoneal metastases of gastric cancer. The value of laparoscopy, PET/CT, DW-MRI, and new PET tracers such as 18F-FLT needs to be studied in future.
胃癌的肝转移和腹膜转移是手术的禁忌证。因此，系统地回顾影像检查在预测胃癌肝转移和腹膜转移术前状态中的作用非常重要。
在 Pubmed/Medline、Embase、The Cochrane Library 和中国生物医学文献数据库中进行了相关文献的系统回顾。使用 QUADAS 评估纳入研究的方法学质量，并使用双变量模型进行此荟萃分析。
共纳入 33 项研究（8 项美国研究、5 项 EUS 研究、22 项 CT 研究、2 项 MRI 研究和 5 项 18F-FDG PET 研究），纳入研究的方法学质量为中等。荟萃分析结果表明，CT 是检测肝转移最敏感的影像学方法[0.74（95%CI：0.59-0.85）]，特异性较高[0.99（95%CI：0.97-1.00）]，EUS 是检测腹膜转移最敏感的影像学方法[0.34（95%CI：0.10-0.69）]，特异性为 0.96（95%CI：0.87-0.99）。仅纳入了两项符合条件的 MRI 研究，且数据未进行合并。这两项研究发现 MRI 在检测肝转移方面均具有较高的敏感性和特异性。
US、EUS、CT 和 18F-FDG PET 用于评估胃癌肝转移和腹膜转移的敏感性和特异性不一致。未来需要研究腹腔镜、PET/CT、DW-MRI 以及 18F-FLT 等新型 PET 示踪剂的价值。
