How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

Table 1 Characteristics of studies included in this meta-analysis for calculating diagnostic accuracy of EUS for gastric cancer staging

No.	Author	Year of publication	No. of patients	Type of study	Confirmatory procedure
1	Grimm et al[28]	1993	147	Prospective	Surgery
2	Francois et al[29]	1996	29	Consecutive	Surgery
3	Schimizu et al[30]	1994	125	Consecutive	Surgery
4	Dittler et al[31]	1993	254	Consecutive	Surgery
5	Ziegler et al[32]	1993	118	Prospective	Surgery
6	Botet et al[33]	1991	50	Prospective	Surgery
7	Xi et al[34]	2003	35	Prospective	Surgery
8	Caletti et al[35]	1991	42	Prospective	Surgery
9	Akahoshi et al[36]	1989	74	Prospective	Surgery
10	Tio et al[37]	1989	72	Prospective	Surgery
11	Massari et al[38]	1996	99	Prospective	Surgery
12	Saito et al[39]	1991	110	Prospective	Surgery
13	Murata et al[40]	1988	146	Prospective	Surgery
14	Hunerbein et al[41]	1996	19	Consecutive	Surgery
15	Perng et al[42]	1996	69	Consecutive	Surgery
16	Tio et al[43]	1989	75	Prospective	Surgery
17	Tio et al[44]	1986	36	Prospective	Surgery
18	Shimoyama et al[45]	2004	45	Consecutive	Surgery
19	Willis et al[46]	2000	116	Consecutive	Surgery
20	Rosch et al[47]	1992	41	Consecutive	Surgery
21	Javaid et al[48]	2003	112	Consecutive	Surgery
22	Potrc et al	2006	82	Prospective	Surgery

Table 2 Accuracy of EUS with confidence intervals to diagnose T and N stages in gastric cancer patients

	Pooled sensitivity	Pooled specificity	Pooled LR+	Pooled LR-	Pooled DOR
T1	88.1% (84.5-91.1)	100.0% (99.7-100.0)	90.1 (48.9-165.7)	0.17 (0.10-0.28)	605.6 (296.8-1235.6)
T2	82.3% (78.2-86.0)	95.6% (94.4-96.6)	17.3 (10.9-27.5)	0.23 (0.17-0.290	108.6 (56.6-208.1)
T3	89.7% (87.1-92.0)	94.7% (93.3-95.9)	14.3 (10.3-19.8)	0.13 (0.08-0.19)	144.4 (95.4-218.7)
T4	99.2% (97.1-99.9)	96.7% (95.7-97.6)	19.6 (14.1-27.2)	0.07 (0.04-0.12)	507.8 (247.5-1042.1)
N1	58.2% (53.5-62.8)	87.2% (84.4-89.7)	4.1 (2.4-7.1)	0.49 (0.41-0.58)	9.5 (5.3-16.9)
N2	64.9% (60.8-68.8)	92.4% (89.9-94.4)	6.7 (4.1-10.9)	0.39 (0.31-0.49)	26.6 (13.9-50.7)

LR+: Positive likelihood Ratio, LR-: Negative likelihood Ratio, DOR: Diagnostic odds ratio.

Table 3 Accuracy of EUS with confidence intervals to stage gastric cancers over the past two decades

		No. of studies	Pooled sensitivity	Pooled specificity	Pooled LR+	Pooled LR-	Pooled DOR
T1	1986 to 1994	12	56.3 % (49.7-62.6)	89.1% (85.5-92.1)	4.6 (1.6-13.8)	0.51 (0.38-0.69)	9.3 (2.9-30.1)
	1995 to 1999	4	82.2 % (67.9-92.0)	100.0 % (97.9-100.0)	72.9 (18.2-288.8)	0.13 (0.03-0.68)	562.5 (92.0-3438.4)
	2000 to 1006	5	84.8% (71.1-93.7)	100.0% (98.9-100.0)	88.9 (25.3-312.4)	0.22 (0.13-0.38)	428.9 (96.6-1904.9)
T2	1986 to 1994	12	84.9% (79.8-89.2)	96.7% (95.4-97.8)	20.5 (14.8-28.4)	0.19 (0.13-0.30)	207.0 (109.5-391.6)
	1995 to 1999	4	74.4% (57.9-87.0)	90.9% (85.4-94.8)	6.7 (2.5-18.1)	0.33 (0.19-0.55)	23.7 (5.3-106.2)
	2000 to 1006	5	79.5% (70.8-86.5)	94.6 % (91.3-96.9)	16.8 (5.3-53.8)	0.22 (0.12-0.38)	79.6 (22.9-277.2)
T3	1986 to 1994	12	89.6% (86.3-92.3)	95.3% (93.6-96.7)	15.5 (11.4-21.1)	0.12 (0.07-0.22)	160.2 (95.5-268.7)
	1995 to 1999	4	90.3% (80.1-96.4)	91.3% (85.8-95.2)	11.1 (3.5-35.4)	0.12 (0.06-0.25)	93.3 (30.6-284.6)
	2000 to 1006	5	89.8% (83.3-94.5)	94.8% (91.3-97.2)	13.9 (7.7-25.1)	0.12 (0.04-0.37)	154.7 (55.7-429.5)
T4	1986 to 1994	12	98.9% (95.9-99.9)	97.1% (95.9-98.0)	23.3 (14.6-37.4)	0.07 (0.04-0.14)	626.4 (256.1-1532.5)
	1995 to 1999	4	100% (92.5-100.0)	95.8% (91.5-98.3)	14.3 (7.6-26.9)	0.05 (0.01-0.18)	441.7 (85.6-2279.1)
	2000 to 1006	3	100.0% (87.2-100.0)	95.7% (91.9-98.0)	16.4 (7.9-33.9)	0.07 (0.02-0.33)	260.1 (43.7-1547.4)
N1	1986 to 1994	10	56.3% (49-62.6)	89.1% (85.5-92.1)	4.6 (1.6-13.6)	0.5 (0.4-0.7)	9.3 (2.9-30.1)
	1995 to 1999	4	64.6% (53.3-74.9)	83.5% (74.9-90.1)	3.6 (2.3-5.6)	0.5 (0.4-0.6)	8.8 (4.3-18.1)
	2000 to 2006	5	57.8% (49.0-66.20)	85.5% (79.3-90.4)	4.4 (2.9-6.6)	0.5 (0.3-0.7)	10.2 (4.8-21.8)
N2	1986 to 1994	10	70.6% (65.4-75.5)	94.7% (91.7-96.8)	11.0 (4.6-26.6)	0.3 (0.2-0.4)	63.9 (30.9-132.3)
	1995 to 1999	4	70.2% (59.9-79.2)	83.2% (74.1-90.1)	3.9 (2.5-6.1)	0.4 (0.3-0.5)	11.7 (5.6-24.1)
	2000 to 2006	4	49.0% (40.7-57.30)	93.0% (87.5-96.6)	6.4 (1.7-24.1)	0.6 (0.4-0.7)	12.7 (2.9-56.2)