Computed tomography vs. endoscopic ultrasonography for preoperative gastric cancer Staging: A meta-analysis

This study aimed to perform a systematic review and meta-analysis to compare the sensitivity, specificity, and overall diagnostic performance of computed tomography (CT) and endoscopic ultrasonography (EUS) in the preoperative tumor (T) and lymph node (N) staging of gastric cancer, thereby providing evidence-based guidance for clinical imaging evaluation. A comprehensive literature search was conducted in PubMed, Web of Science, Embase, Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases to identify prospective and retrospective clinical studies involving patients with histologically confirmed gastric cancer who underwent both CT and EUS for preoperative staging. Sensitivity, specificity, and corresponding 95 % confidence intervals (CIs) were extracted from each study. A random-effects model was employed for pooled analysis, and summary receiver operating characteristic (SROC) curves were constructed to evaluate the overall diagnostic accuracy of the two imaging modalities. A total of seven studies involving 1031 patients were included, all of which compared the diagnostic performance of CT and EUS in tumor (T) and lymph node (N) staging of gastric cancer. For T staging, EUS demonstrated superior sensitivity (with some studies reporting up to 0.94 [0.82, 0.99]), although its specificity showed considerable variability ( e.g., 0.67 [0.09, 0.99]). In contrast, CT exhibited consistently high specificity ( e.g., 1.00) but lower sensitivity ( e.g., 0.65 [0.50, 0.78]). For N staging, EUS sensitivity varied markedly across studies (ranging from 0.19 [0.15, 0.25] to 0.98 [0.89, 1.00]), whereas CT maintained high specificity despite its limited sensitivity ( e.g., 1.00). SROC curve analysis indicated that EUS had superior overall diagnostic accuracy compared to CT, particularly in high-sensitivity domains. EUS demonstrates superior sensitivity in the preoperative T and N staging of gastric cancer, making it effective in detecting positive cases, whereas CT provides higher specificity and reliably excludes negative cases. From a clinical perspective, to maximize diagnostic precision, the combined use of EUS and CT is strongly recommended. This dual-modality strategy leverages the strengths of both techniques—EUS for accurate detection of positive lesions and CT for effective exclusion of negative findings—thereby offering a more comprehensive imaging basis for preoperative staging and facilitating optimized treatment planning.