A systematic review of the staging performance of endoscopic ultrasound ingastro-oesophageal carcinoma

Background-Endoscopic ultrasound (EUS) may be used for preoperative staging of gastro-oesophageal carcinoma but performance values given in the litera ture differ. Aims-To identify and synthesise findings from all articles on the performan ce of EUS in tumour, node, metastasis (TNM) staging of gastro-oesophageal c arcinoma. Source-Published and unpublished English language literature, 198 1-1996. Methods-Data on the staging performance of EUS were retrieved and evaluated . Summary receiver operator characteristic methodology was used for synthes is, and a summary estimate of performance, Q*, obtained. Multiple regressio n analysis was used to assess study validity and investigate reasons for di fferences in performance. Results-Twenty seven primary articles were assessed in detail. Thirteen sup plied results for staging oesophageal cancer, 13 for gastric cancer, and fo ur for cancers at the gastro-oesophageal junction. For gastric T staging, Q *=0.93 (95% confidence interval (CI) 0.91-0.95) and for oesophageal T stagi ng, Q*=0.89 (95% CI 0.88-0.92). For gastro-oesophageal T staging, including cancers at the gastrooesophageal junction, Q*=0.91 (95% CI 0.89-0.93). Inc lusion of cases with non-traversable stenosis was found to slightly reduce staging performance. For N staging, Q*=0.79 (95% CI 0.75-0.83). In articles that compared EUS directly with incremental computed tomography, EUS perfo rmed better. None of the variables assessed in the regression analysis was significant using a Bonferroni correction. Three variables (anatomical loca tion, traversability, and blinding) showed strong relationships for future research and validation. Conclusions-EUS is highly effective for discrimination of stages T1 and T2 from stages T3 and T4 for primary gastrooesophageal carcinomas. The failure rate of EUS from non-traversability of a stenotic cancer may be a limitati on in some patient groups.