Imaging in Local Staging of Gastric Cancer: A Systematic Review

Purpose Endoscopic ultrasound (EUS) has been established as the diagnostic modality of choice in local (T) staging of gastric cancer. Multidetector row computed tomography (MDCT) and magnetic resonance imaging (MRI) are promising alternatives. The aim of this study was to systematically review the literature regarding the performance of each of these imaging modalities. Methods A systematic search for relevant studies was performed in the PubMed/MEDLINE and EMBASE databases. Two reviewers independently assessed the methodological quality of each study. Local staging performance of included studies was calculated. Results Twenty-two EUS studies, five MDCT studies, one combined EUS and MDCT study, and three MRI studies met the inclusion criteria. The studies were of moderate methodological quality. Diagnostic accuracy of overall T staging for EUS, MDCT, and MRI varied between 65% to 92.1%, 77.1% to 88.9%, and 71.4% to 82.6%, respectively. Sensitivity for assessing serosal involvement for EUS, MDCT, and MRI varied between 77.8% to 100%, 82.8% to 100%, and 89.5% to 93.1%, respectively. Specificity for assessing serosal involvement for EUS, MDCT, and MRI varied between 67.9% to 100%, 80% to 96.8%, and 91.4% to 100%, respectively. Conclusion EUS, MDCT, and MRI achieve similar results in terms of diagnostic accuracy in T staging and in assessing serosal involvement. Most experience has been gained with EUS. Few MDCT studies and even fewer MRI studies are available. Thus, EUS remains the first-choice imaging modality in preoperative T staging of gastric cancer.