Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2280
Peer-review started: March 12, 2023
First decision: May 9, 2023
Revised: May 16, 2023
Accepted: June 12, 2023
Article in press: June 12, 2023
Published online: October 27, 2023
Processing time: 228 Days and 18.3 Hours
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 Reference Citations Analysis (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.
Core Tip: This systematic review aimed to compare the efficacy of staging laparoscopy against computed tomography (CT) scanning in the diagnosis of peritoneal metastases, where staging laparoscopy was found to be unequivocally superior. We then proceeded to investigate the efficacy of CT scans against positron emission tomography (PET) and magnetic resonance imaging (MRI) scans. CT scans were marginally better than PET scans but were slightly inferior to MRI scans based on the measured domains. Radiomic modelling has also been shown to have the potential to become a promising alternative for predicting peritoneal metastases with further research.