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
Staging laparoscopy is currently the gold standard for diagnosing peritoneal metastasis in gastric cancer patients. However, this procedure comes with risks of general anaesthesia and surgery which are of importance in elderly and frail patients, the demographic most affected by gastric cancer. Hence, we sought to evaluate non-invasive alternatives to staging laparoscopy with comparable accuracy.
Staging laparoscopy remains the gold standard for diagnosing peritoneal metastasis in gastric cancer patients, which comes with risks of general anaesthesia and surgery. Many non-invasive diagnostic modalities are available in the current day and age, hence, we sought to evaluate non-invasive alternatives to staging laparoscopy that may provide us with comparable accuracy. With further research in this field, along with newer developments such as radiomic modelling and new radiotracers, there is great potential for developing such a diagnostic tool with comparable or even greater accuracy than staging laparoscopy.
We sought to determine if computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) could be a potential non-invasive yet accurate alternative to staging laparoscopy.
Data from relevant studies that reported patients with peritoneal metastasis secondary to gastric cancer diagnosed by non-invasive scans were extracted and presented according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Significant data such as sensitivity, specificity, negative and positive predictive values were analysed and compared between diagnostic modalities in our systematic review.
Our findings suggested that staging laparoscopy still delivered the best results in terms of sensitivity, specificity, negative and positive predictive values when compared to CT scans in diagnosing peritoneal metastasis in advanced gastric cancer. MRI had generally outperformed CT scans which had in turn, generally performed better than PET scans. Despite this, the difference in performance between all the diagnostic modalities are marginal, suggesting that there is great potential for the development of the ideal diagnostic tool capable of providing us with the same or even better accuracy than staging laparoscopy, while remaining non-invasive. With additional tools such as radiomic modelling and new radiotracers, the development of such a diagnostic modality may be possible sooner than expected.
Although staging laparoscopy remains superior to other non-invasive diagnostic modalities in the detection of peritoneal metastasis in advanced gastric cancer, the potential for developing a comparable or even better diagnostic tool is great. This may be achieved with new technologies such as radiomic modelling and new radiotracers, on top of the already advanced capabilities of CT, MRI and PET scans. With further research, this breakthrough may be possible sooner than expected.
Given the rapid and enthusiastic development of new technologies in diagnostic tools, the development of a highly sensitive and specific non-invasive alternative to staging laparoscopy in peritoneal metastasis detection is highly likely with further research. On top of the already cutting edge diagnostic modalities, additional improvements and developments may bring us closer than ever to this goal.