Ho Si Ying Adelina, Tay Kon Voi
Lee Kong Chian School of Medicine, Singapore 308232, Singapore.
Upper GI and Bariatric Division, General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
World J Gastrointest Surg. 2023 Oct 27;15(10):2280-2293. doi: 10.4240/wjgs.v15.i10.2280.
Gastric cancer is one of the leading causes of cancer burden and mortality, often resulting in peritoneal metastasis in advanced stages with negative survival outcomes. Staging laparoscopy has become standard practice for suspected cases before a definitive gastrectomy or palliation. This systematic review aims to compare the efficacy of other diagnostic modalities instead of staging laparoscopy as the alternatives are able to reduce cost and invasive staging procedures. Recently, a radiomic model based on computed tomography and positron emission tomography (PET) has also emerged as another method to predict peritoneal metastasis.
To determine if the efficacy of computed tomography, magnetic resonance imaging and PET is comparable with staging laparoscopy.
Articles comparing computed tomography, PET, magnetic resonance imaging, and radiomic models based on computed tomography and PET to staging laparoscopies were filtered out from the Cochrane Library, EMBASE, PubMed, Web of Science, and (https://www.referencecitationanalysis.com/). In the search for studies comparing computed tomography (CT) to staging laparoscopy, five retrospective studies and three prospective studies were found. Similarly, five retrospective studies and two prospective studies were also included for papers comparing CT to PET scans. Only one retrospective study and one prospective study were found to be suitable for papers comparing CT to magnetic resonance imaging scans.
Staging laparoscopy outperformed computed tomography in all measured aspects, namely sensitivity, specificity, positive predictive value and negative predictive value. Magnetic resonance imaging and PET produced mixed results, with the former shown to be only marginally better than computed tomography. CT performed slightly better than PET in most measured domains, except in specificity and true negative rates. We speculate that this may be due to the limited F-fluorodeoxyglucose uptake in small peritoneal metastases and in linitis plastica. Radiomic modelling, in its current state, shows promise as an alternative for predicting peritoneal metastases. With further research, deep learning and radiomic modelling can be refined and potentially applied as a preoperative diagnostic tool to reduce the need for invasive staging laparoscopy.
Staging laparoscopy was superior in all measured aspects. However, associated risks and costs must be considered. Refinements in radiomic modelling are necessary to establish it as a reliable screening technique.
胃癌是癌症负担和死亡率的主要原因之一，晚期常导致腹膜转移，生存结局不佳。在进行确定性胃切除术或姑息治疗之前，分期腹腔镜检查已成为疑似病例的标准做法。本系统评价旨在比较其他诊断方法的疗效，因为这些替代方法能够降低成本和减少侵入性分期程序。最近，基于计算机断层扫描（CT）和正电子发射断层扫描（PET）的放射组学模型也已成为预测腹膜转移的另一种方法。
确定CT、磁共振成像（MRI）和PET的疗效是否与分期腹腔镜检查相当。
从Cochrane图书馆、EMBASE、PubMed、Web of Science以及（https://www.referencecitationanalysis.com/）中筛选出比较CT、PET、MRI以及基于CT和PET的放射组学模型与分期腹腔镜检查的文章。在搜索比较CT与分期腹腔镜检查的研究时，发现了五项回顾性研究和三项前瞻性研究。同样，在比较CT与PET扫描的论文中，也纳入了五项回顾性研究和两项前瞻性研究。在比较CT与MRI扫描的论文中，仅发现一项回顾性研究和一项前瞻性研究合适。
在所有测量方面，即敏感性、特异性、阳性预测值和阴性预测值，分期腹腔镜检查均优于CT。MRI和PET的结果不一，前者仅略优于CT。在大多数测量领域，CT的表现略优于PET，但在特异性和真阴性率方面除外。我们推测这可能是由于小的腹膜转移灶和皮革胃中氟脱氧葡萄糖摄取有限所致。目前状态下的放射组学建模显示出作为预测腹膜转移替代方法的前景。随着进一步研究，深度学习和放射组学建模可以得到改进，并有可能作为术前诊断工具应用以减少对侵入性分期腹腔镜检查的需求。
分期腹腔镜检查在所有测量方面均更具优势。然而，必须考虑相关风险和成本。放射组学建模的改进对于将其确立为可靠的筛查技术是必要的。
