How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

Author Seevaratnam, Rajini Google Scholar
Cardoso, Roberta Google Scholar
Mcgregor, Caitlin Google Scholar
Lourenço, Laércio Gomes Autor UNIFESP Google Scholar
Mahar, Alyson Google Scholar
Sutradhar, Rinku Google Scholar
Law, Calvin Google Scholar
Paszat, Lawrence Google Scholar
Coburn, Natalie Google Scholar
Institution Sunnybrook Hlth Sci Ctr
Universidade Federal de São Paulo (UNIFESP)
Queens Univ
Univ Toronto
Inst Clin Evaluat Sci
Abstract Background Surgery is the fundamental curative option for gastric cancer patients. Imaging scans are routinely prescribed in an attempt to stage the disease prior to surgery. Consequently, the correlation between radiology exams and pathology is crucial for appropriate treatment planning.Methods Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 1, 2009. We calculated the accuracy, overstaging rate, understaging rate, Kappa statistic, sensitivity, and specificity for abdominal ultrasound (AUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) with respect to the gold standard (pathology). We also compared the performance of CT by detector number and image type. A meta-analysis was performed.Results for pre-operative T staging MRI scans had better performance accuracy than CT and AUS; CT scanners using >= 4 detectors and multi-planar reformatted (MPR) images had higher staging performances than scanners with <4 detectors and axial images only. for pre-operative N staging PET had the lowest sensitivity, but the highest specificity among modalities; CT performance did not significantly differ by detector number or addition of MPR images. for pre-operative M staging performance did not significantly differ by modality, detector number, or MPR images.Conclusions the agreement between pre-operative TNM staging by imaging scans and post-operative staging by pathology is not perfect and may affect treatment decisions. Operator dependence and heterogeneity of data may account for the variations in staging performance. Physicians should consider this discrepancy when creating their treatment plans.
Keywords Abdominal ultrasound (AUS)
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Gastric cancer
Language English
Sponsor Canadian Cancer Society
Ontario Ministry of Health and Long-Term Care
Hanna Family Chair in Surgical Oncology
Grant number Canadian Cancer Society: 019325
Date 2012-09-01
Published in Gastric Cancer. New York: Springer, v. 15, p. S3-S18, 2012.
ISSN 1436-3291 (Sherpa/Romeo, impact factor)
Publisher Springer
Extent S3-S18
Access rights Closed access
Type Review
Web of Science ID WOS:000313419000003

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