Abstract
BackgroundHepatic and peritoneal metastases of gastric cancer are operation contraindications. Systematic review to provide an overview of imaging in predicting the status of liver and peritoneum pre-therapeuticly is essential.MethodsA systematic review of relevant literatures was performed in Pubmed/Medline, Embase, The Cochrane Library and the China Biological Medicine Databases. QUADAS was used for assessing the methodological quality of included studies and the bivariate model was used for this meta-analysis.ResultsTotally 33 studies were included (8 US studies, 5 EUS studies, 22 CT studies, 2 MRI studies and 5 18F-FDG PET studies) and the methodological quality of included studies was moderate. The result of meta-analysis showed that CT is the most sensitive imaging method [0.74 (95% CI: 0.59-0.85)] with a high rate of specificity [0.99 (95% CI: 0.97-1.00)] in detecting hepatic metastasis, and EUS is the most sensitive imaging modality [0.34 (95% CI: 0.10-0.69) ] with a specificity of 0.96 (95% CI: 0.87-0.99) in detecting peritoneal metastasis. Only two eligible MRI studies were identified and the data were not combined. The two studies found that MRI had both high sensitivity and specificity in detecting liver metastasis.ConclusionUS, EUS, CT and 18F-FDG PET did not obtain consistently high sensitivity and specificity in assessing liver and peritoneal metastases of gastric cancer. The value of laparoscopy, PET/CT, DW-MRI, and new PET tracers such as 18F-FLT needs to be studied in future.
Highlights
Hepatic and peritoneal metastases of gastric cancer are operation contraindications
By screening the tittles and abstracts we found that lots of articles were irrelevant and some were identified in more than one database, 101 studies remained for potential inclusion and were obtained in full-text version
The mainly reasons for excluded studies were as follows: non-original research(eg. review articles), not reporting the diagnostic performance of liver or peritoneal metastasis, insufficient data to construct a 2 × 2 contingency table, inclusion of patients with nonadenocarcinoma, gastric carcinoma confined to a specific part of the stomach or included patients received neoadjuvant chemotherapy
Summary
Hepatic and peritoneal metastases of gastric cancer are operation contraindications. Systematic review to provide an overview of imaging in predicting the status of liver and peritoneum pre-therapeuticly is essential. Peritoneal metastasis, mainly induced by the dissemination of Studies suggested that imaging methods of evaluating the pre-operative status of hepatic and peritoneal metastases have two effects [9,10]: 1) avoiding unnecessary laparotomy; 2) assessing the effectiveness of neoadjuvant protocols in the absence of histopathological confirmation. Systematic review and meta-analysis of imaging in assessing local staging and lymph node status of gastric cancer were performed [11,12], there is no consensus on the most sensitive imaging method for detecting hepatic and peritoneal metastases of gastric cancer now. Pre-operative staging of gastric cancer should mainly focus on assessing distant metastases but not local staging or lymph node status, since if one patient has distant metastases, an exploratory laparotomy always can be avoided [13]
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