A Meta-Analysis And Systematic Review Of Accuracy Of Endoscopic Ultrasound For N Staging Of Gastric Cancers

Figures & data

Table 1 Main Features Of The 50 Eligible Studies (N=5223) Included Studies

ID	Sample Size	Country	Conformatory Test	Equipment	Frequency (MHz)	Stomach Site
Tio et al, 1986^Citation27	11	Netherlands	Surgery	Radial	Unreported	Any
Murata et al, 1988^Citation28	146	Japan	Surgery	Radial	7.5–10	Any
Tio et al, 1989^Citation29	80	Netherlands	Surgery	Radial	7.5–12	Any
Botet et al, 1991^Citation30	50	United states	Surgery	Radial	7.5–12	Any
Cerizzi et al, 1991^Citation31	21	Italy	Surgery	Radial	7.5–12	Any
Caletti et al, 1993^Citation32	35	Italy	Surgery	Radial	7.5–12	Any
Dittler et al, 1993^Citation33	254	Germany	Surgery	Radial	7.5–12	Any
Grimm et al, 1993^Citation34	147	Germany	Surgery	Radial	7.5	Any
Ziegler et al, 1993^Citation35	108	Germany	Surgery	Radial	7.5–20	Any
Francois et al, 1996^Citation36	29	France	Surgery	Radial	7.5–12	Cardia
Massari et al,1996^Citation37	65	Italy	Surgery	Radial	7.5–12	Any
Perng et al, 1996^Citation38	76	Taiwan	Surgery	Radial	7.5–12	Any
Hamada et al, 1997^Citation39	149	Japan	Surgery	Radial	7.5–20	Any
Akahoshi et al, 1998^Citation40	73	Japan	Surgery	Radial	15	Any
Hunerbein et al, 1998^Citation41	22	Germany	Surgery	Radial	12.5	Any
Wang et al, 1998^Citation42	119	Taiwan	Surgery	Radial	7.5–12	Any
De Manzoni et al, 1999^Citation43	29	Italy	Surgery	Radial	7.5	Cardia
Nakamura et al, 1999^Citation44	31	Japan	Surgery	NR	NR	Any
Mancino et al, 2000^Citation45	79	Italy	Surgery	Radial	7.5–12	Any
Tseng et al, 2000^Citation46	74	Taiwan	Surgery	Radial	7.5–12	Any
Willis et al, 2000^Citation47	116	Germany	Surgery	Radial	7.5–12	Any
Chen et al, 2002^Citation48	57	Taiwan	Surgery	Radial	7.5–20	Any
Xi et al, 2003^Citation49	32	China	Surgery	Radial	7.5–20	Any
Bhandari et al, 2004^Citation50	48	Korea	EMR or Surgery	Radial	20	Any
Habermann et al, 2004^Citation51	51	Germany	Surgery	Radial	7.5–12	Any
Javaid et al, 2004^Citation52	112	India	Surgery	Radial	7.5	Any
Polkowski et al, 2004^Citation53	88	Poland	Surgery	Radial	7.5–12	Any
Shimoyama et al, 2004^Citation54	45	Japan	Surgery	Linear	7.5	Cardia
Lee et al, 2005^Citation55	241	China	Surgery	Linear	7.5, 12	Any
Pedrazzani et al, 2005^Citation56	51	Italy	Surgery	Linear	7.5	Cardia
Ang et al, 2006^Citation57	57	Singapore	Surgery	Radial	7.5–12	Any
Arocena et al, 2006^Citation58	17	Spain	Surgery	Linear	12.5	Any
Ganpathi et al, 2006^Citation59	102	Singapore	Surgery	Radial	7.5–12	Any
Potrc et al, 2006^Citation60	82	Slovenia	Surgery	Radial	7.5–12	Any
Tsendsuren et al, 2006^Citation61	41	China	Surgery	Linear	5–7.5	Any
Barbour et al, 2007^Citation62	206	USA	Surgery	Radial	7.5–12	Cardia
Bentrem et al, 2007^Citation63	218	United States	Surgery	NR	7.5–12	Any
Tan et al, 2007^Citation64	63	China	Surgery	Radial	7.5–20	Any
Blackshaw et al, 2008^Citation65	44	UK	Surgery	Radial	7.5–12	Cardia
Lok et al, 2008^Citation66	75	Hong Kong	Surgery	Radial	12–20	Any
Park et al, 2008^Citation67	40	Korea	Surgery	Radial	7.5-–12	Any
Ahn et al, 2009^Citation68	71	Korea	Surgery	Radial	5–12	Any
Hwang et al, 2010^Citation21	277	Korea	Surgery	Radial	5–20	Any
Repiso et al, 2010^Citation69	36	Spain	Surgery	Radial	7.5–20	Any
Bohle et al, 2011^Citation70	62	Germany	Surgery	Radial	20	Any
Zheng 2011^Citation71	165	China	Surgery	Radial	7.5–12	Any
Kutup et al, 2012^Citation72	123	Germany	Surgery	Radial	7.5–12	Any
Spolverato et al, 2015^Citation73	149	USA	Surgery	Radial	7.5–12	Any
Giganti et al, 2016^Citation74	52	Italy	Surgery	Radial	5–10	Any
Serrano et al, 2016^Citation75	69	USA	Surgery	Radial	7.5,10	Any

Figure 1 Flowchart illustrating the selection of studies.

Figure 2 Graphical display for QUADAS-2 results regarding the proportion of studies with low, high, or unclear risk of bias.

Figure 3 EUS diagnostic performance to distinguish lymph node-positive from lymph node-negative tumors: forest plot of the studies included in the meta-analysis.

Figure 4 Hierarchic summary receiver operating characteristic (ROC) (solid line) plot with summary point with 95% CI area (circled area).

Figure 5 EUS diagnostic performance to distinguish lymph node-positive from lymph node-negative tumors: Fagan plot (Bayesian nomogram).

Table 2 Subgroup And Sensitivity Analysis For N0 Versus N+ Gastric Tumors

Variable	Category	Studies	Sensitivity (95% CI)	Specificity (95% CI)	P Value
Sample size	>100	14	0.82 [0.76–0.88]	0.70 [0.61–0.78]	0.96
<100	36	0.82 [0.77–0.87]	0.68 [0.62–0.75]
Year of publication	2000 or later	32	0.81 [0.76–0.86]	0.66 [0.60–0.72]	0.02
Before 2000	18	0.85 [0.79–0.91]	0.74 [0.67–0.82]
Country	Western	28	0.79 [0.73–0.85]	0.73 [0.67–0.79]	0.12
Eastern	22	0.85 [0.81–0.90]	0.64 [0.56–0.71]
EUS array	Radial	44	0.82 [0.78–0.86]	0.70 [0.64–0.75]	0.67
Linear	6	0.84 [0.74–0.94]	0.62 [0.46–0.78]
Tumor site	Cardia region	6	0.83 [0.71–0.94]	0.76 [0.63–0.88]	0.46
Any site	44	0.82 [0.78–0.86]	0.68 [0.62–0.73]

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