Comparison of the diagnostic accuracy of enhanced-CT and Double Contrast-Enhanced Ultrasound for preoperative T-staging of gastric cancer: a meta-analysis

明月 吕 ^1,2 Xu Hui ^2,3,4 Xin Yang ^1,5 SuSu Li ¹ ZhiGuo Mao ¹ XinHua Zhang ^1,6 Kehu Yang ^4,7,8*

• ¹ The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China
• ² Evidence-Based Medicine Centre, School of Basic Medical Science, Lanzhou University, 730000, Lanzhou, China, Lanzhou, Gansu Province, China
• ³ Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University, 730000, Lanzhou, China, LanZhou, China
• ⁴ Gansu Key Laboratory of Evidence-Based Medicine, Lanzhou University, 730000, Lanzhou, China, LanZhou, China
• ⁵ 2.Evidence-Based Medicine Centre, School of Basic Medical Science, Lanzhou University, 730000, Lanzhou, China, LanZhou, China
• ⁶ Department of Ultrasound Medicine, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
• ⁷ Evidence-Based Medicine Centre, School of Basic Medical Science, Lanzhou University, 730000, Lanzhou, LanZhou, China
• ⁸ Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University, LanZhou, China

Background: Accurate preoperative staging of gastric cancer (GC) relies on effective diagnostic methods. Enhanced computed tomography (enhanced-CT) is a widely used tool, while Double Contrast-Enhanced Ultrasound (DCEUS) offers superior visualization of gastric wall layers and higher sensitivity (SE) and specificity (SP).Objective: This study aims to compare the preoperative T-staging accuracy of DCEUS and enhanced-CT through a comprehensive meta-analysis.Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library from inception to February 19, 2024. Eligible studies included prospective and retrospective research on GC patients undergoing DCEUS or enhanced-CT, encompassing both comparative (CDTA) and single-modality (SDTA) diagnostic studies. Risk of bias was assessed using QUADAS-C and QUADAS-2 tools, and evidence quality was evaluated using GRADE.Results: The meta-analysis included 39 studies with 6,374 patients. Among these, 3 studies (319 patients) directly compared DCEUS and enhanced-CT, 31 studies (5,180 patients) evaluated enhanced-CT alone, and 5 studies (875 patients) assessed DCEUS alone. In direct comparisons, DCEUS showed higher SE and SP for T1-T4 staging, with moderate to low certainty of evidence, particularly excelling in early-stage (T1) and advanced-stage (T4) detection. Enhanced-CT, though effective, had lower sensitivity, especially for T1 tumors. In SDTA studies, DCEUS demonstrated higher sensitivity for T2-T4 staging with comparable specificity, though evidence certainty was very low.Conclusion: DCEUS is a promising modality for GC T-staging, particularly for early-stage detection. However, the limited number of direct comparative studies highlights the need for further high-quality research to validate these findings. Current evidence suggests DCEUS outperforms enhanced-CT in SE and diagnostic accuracy while maintaining comparable SP.