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Mycoses Jul 2021We performed this study to provide the latest evidence of the diagnostic accuracy of all Aspergillus antibodies for chronic pulmonary aspergillosis (CPA). In this... (Meta-Analysis)
Meta-Analysis Review
We performed this study to provide the latest evidence of the diagnostic accuracy of all Aspergillus antibodies for chronic pulmonary aspergillosis (CPA). In this meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and other databases, until 19 March 2020, for studies that examined the diagnostic accuracy of each Aspergillus-specific antibody for CPA and assessed the risk of bias using the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. We integrated the results using a hierarchical summary receiver operating characteristic (HSROC) model and calculated the point estimates of specificity with sensitivity fixed at 0.90 using the HSROC curve. We identified 32 published and one unpublished studies, including 75 studies on five antibody test types: 18 of precipitin test (2810 participants), 46 of IgG (8197), three of IgA (283), six of IgM (733) and two of combined IgG and IgM (IgG + IgM) (920). The results of specificity with sensitivity fixed at 0.90 were as follows: precipitin test, 0.93 (95% credible intervals: 0.86, 1.00); IgG, 0.90 (0.86, 0.95); IgA, 0.74 (0.00, 1.00); IgM, 0.50 (0.37, 0.53); IgG + IgM, 0.47 (0.00, 1.00). However, the precipitin test showed imprecision and instability in the sensitivity analysis. Most studies had a high risk of bias due to the case-control design. Although there is lack of applicability for malignancy or immunosuppressive patients, our study suggests a preference for IgG over other antibody tests in CPA screening. Particularly, IgG should be used as an adjunct when ruling out CPA.
Topics: Antibodies, Fungal; Aspergillus; Chronic Disease; Diagnostic Tests, Routine; Enzyme-Linked Immunosorbent Assay; Immunocompromised Host; Immunoglobulin G; Immunologic Tests; Pulmonary Aspergillosis; ROC Curve; Sensitivity and Specificity
PubMed: 33594774
DOI: 10.1111/myc.13253 -
Journal of Clinical Epidemiology Oct 2013To classify the sources of bias and variation and to provide an updated summary of the evidence of the effects of each source of bias and variation. (Review)
Review
OBJECTIVE
To classify the sources of bias and variation and to provide an updated summary of the evidence of the effects of each source of bias and variation.
STUDY DESIGN AND SETTING
We conducted a systematic review of studies of any design with the main objective of addressing bias or variation in the results of diagnostic accuracy studies. We searched MEDLINE, EMBASE, BIOSIS, the Cochrane Methodology Register, and Database of Abstracts of Reviews of Effects (DARE) from 2001 to October 2011. Citation searches based on three key papers were conducted, and studies from our previous review (search to 2001) were eligible. One reviewer extracted data on the study design, objective, sources of bias and/or variation, and results. A second reviewer checked the extraction.
RESULTS
We summarized the number of studies providing evidence of an effect arising from each source of bias and variation on the estimates of sensitivity, specificity, and overall accuracy.
CONCLUSIONS
We found consistent evidence for the effects of case-control design, observer variability, availability of clinical information, reference standard, partial and differential verification bias, demographic features, and disease prevalence and severity. Effects were generally stronger for sensitivity than for specificity. Evidence for other sources of bias and variation was limited.
Topics: Bias; Diagnostic Tests, Routine; Humans; Review Literature as Topic; Sensitivity and Specificity
PubMed: 23958378
DOI: 10.1016/j.jclinepi.2013.05.014 -
BMJ Open Feb 2018To undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS) point-of-care (POC) tests at antenatal clinics compared with reference standard tests (non-treponemal (TP) and TP tests) for active syphilis in pregnant women.
METHODS
Five electronic databases were searched (PubMed, EMBASE, CRD, Cochrane Library and LILACS) to March 2016 for diagnostic accuracy studies of ICS test and standard reference tests for syphilis in pregnant women. Methodological quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). A bivariate meta-analysis was undertaken to generate pooled estimates of diagnostic parameters. Results were presented using a coupled forest plot of sensitivity and specificity and a scatter plot.
RESULTS
The methodological quality of the five included studies with regards to risk of bias and applicability concern judgements was either low or unclear. One study was judged as high risk of bias for patient selection due to exclusion of pregnant women with a previous history of syphilis, and one study was judged at high risk of bias for study flow and timing as not all patients were included in the analysis. Five studies contributed to the meta-analysis, providing a pooled sensitivity and specificity for ICS of 0.85 (95% CrI: 0.73 to 0.92) and 0.98 (95% CrI: 0.95 to 0.99), respectively.
CONCLUSIONS
This review and meta-analysis observed that rapid ICS POC tests have a high sensitivity and specificity when performed in pregnant women at antenatal clinics. However, the methodological quality of the existing evidence base should be taken into consideration when interpreting these results.
PROSPERO REGISTRATION NUMBER
CRD42016036335.
Topics: Developing Countries; Diagnostic Tests, Routine; Female; Humans; Point-of-Care Systems; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Sensitivity and Specificity; Syphilis
PubMed: 29467132
DOI: 10.1136/bmjopen-2017-018132 -
Sensors (Basel, Switzerland) May 2022Cone-beam breast computed tomography (CBBCT) and digital breast tomosynthesis (DBT) remain the main 3D modalities for X-ray breast imaging. This study aimed to... (Meta-Analysis)
Meta-Analysis Review
Comparison of Diagnostic Test Accuracy of Cone-Beam Breast Computed Tomography and Digital Breast Tomosynthesis for Breast Cancer: A Systematic Review and Meta-Analysis Approach.
BACKGROUND
Cone-beam breast computed tomography (CBBCT) and digital breast tomosynthesis (DBT) remain the main 3D modalities for X-ray breast imaging. This study aimed to systematically evaluate and meta-analyze the comparison of diagnostic accuracy of CBBCT and DBT to characterize breast cancers.
METHODS
Two independent reviewers identified screening on diagnostic studies from 1 January 2015 to 30 December 2021, with at least reported sensitivity and specificity for both CBBCT and DBT. A univariate pooled meta-analysis was performed using the random-effects model to estimate the sensitivity and specificity while other diagnostic parameters like the area under the ROC curve (AUC), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were estimated using the bivariate model.
RESULTS
The pooled sensitivity specificity, LR+ and LR- and AUC at 95% confidence interval are 86.7% (80.3-91.2), 87.0% (79.9-91.8), 6.28 (4.40-8.96), 0.17 (0.12-0.25) and 0.925 for the 17 included studies in DBT arm, respectively, while, 83.7% (54.6-95.7), 71.3% (47.5-87.2), 2.71 (1.39-5.29), 0.20 (0.04-1.05), and 0.831 are the pooled sensitivity specificity, LR+ and LR- and AUC for the five studies in the CBBCT arm, respectively.
CONCLUSIONS
Our study demonstrates that DBT shows improved diagnostic performance over CBBCT regarding all estimated diagnostic parameters; with the statistical improvement in the AUC of DBT over CBBCT. The CBBCT might be a useful modality for breast cancer detection, thus we recommend more prospective studies on CBBCT application.
Topics: Breast Neoplasms; Cone-Beam Computed Tomography; Diagnostic Tests, Routine; Female; Humans; Mammography; Prospective Studies; Sensitivity and Specificity
PubMed: 35591290
DOI: 10.3390/s22093594 -
Gastrointestinal Endoscopy May 2021Diagnosis of esophageal cancer or precursor lesions by endoscopic imaging depends on endoscopist expertise and is inevitably subject to interobserver variability.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Diagnosis of esophageal cancer or precursor lesions by endoscopic imaging depends on endoscopist expertise and is inevitably subject to interobserver variability. Studies on computer-aided diagnosis (CAD) using deep learning or machine learning are on the increase. However, studies with small sample sizes are limited by inadequate statistical strength. Here, we used a meta-analysis to evaluate the diagnostic test accuracy (DTA) of CAD algorithms of esophageal cancers or neoplasms using endoscopic images.
METHODS
Core databases were searched for studies based on endoscopic imaging using CAD algorithms for the diagnosis of esophageal cancer or neoplasms and presenting data on diagnostic performance, and a systematic review and DTA meta-analysis were performed.
RESULTS
Overall, 21 and 19 studies were included in the systematic review and DTA meta-analysis, respectively. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD algorithms for the diagnosis of esophageal cancer or neoplasms in the image-based analysis were 0.97 (95% confidence interval [CI], 0.95-0.99), 0.94 (95% CI, 0.89-0.96), 0.88 (95% CI, 0.76-0.94), and 108 (95% CI, 43-273), respectively. Meta-regression showed no heterogeneity, and no publication bias was detected. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD algorithms for the diagnosis of esophageal cancer invasion depth were 0.96 (95% CI, 0.86-0.99), 0.90 (95% CI, 0.88-0.92), 0.88 (95% CI, 0.83-0.91), and 138 (95% CI, 12-1569), respectively.
CONCLUSIONS
CAD algorithms showed high accuracy for the automatic endoscopic diagnosis of esophageal cancer and neoplasms. The limitation of a lack in performance in external validation and clinical applications should be overcome.
Topics: Computers; Diagnosis, Computer-Assisted; Diagnostic Tests, Routine; Esophageal Neoplasms; Humans; Sensitivity and Specificity
PubMed: 33290771
DOI: 10.1016/j.gie.2020.11.025 -
Musculoskeletal Science & Practice Oct 2017Rising healthcare costs and inherent risks with over-utilizing diagnostic imaging require a quality subjective examination to improve effectiveness and time management... (Review)
Review
UNLABELLED
Rising healthcare costs and inherent risks with over-utilizing diagnostic imaging require a quality subjective examination to improve effectiveness and time management of physical examinations. This systematic review investigates the diagnostic accuracy of subjective history and self-report items to determine if there is significant alteration in the probability of identifying specific painful neck conditions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
INCLUSION CRITERIA
1) Written in the English language 2) Cervical pain with/without referred upper extremity or head pain 3) Subjective history or self-report items 4) Study designs that reported diagnostic statistics or allowed calculation of sensitivities, specificities, diagnostic odds ratios, and likelihood ratios 5) used a reference standard that has a sensitivity or specificity ≥75% or a diagnostic tool that is strongly supported in the literature where this data is not available. Quality Assessment of Studies of Diagnostic Accuracy II was performed to evaluate risk of bias. Five studies with 830 total patients met the inclusion criteria. Conditions commonly reported in the literature included: cervical radiculopathy, cervical myelopathy, degenerative joint disease, and cervicogenic headache. Individual history questions show minimal diagnostic value in identifying cervical conditions without the physical examination. The value of the subjective history report is important and requires further investigation for specific neck conditions. Clustering symptoms may provide more insight than individual history items in future studies. The diagnostic value of history for neck conditions may be underrepresented due to the lack of studies that isolate subjective examination from the physical examination.
LEVEL OF EVIDENCE
3a.
Topics: Adult; Aged; Aged, 80 and over; Diagnostic Tests, Routine; Female; Humans; Male; Medical History Taking; Middle Aged; Neck Pain; Pain Measurement; Self Report; Sensitivity and Specificity
PubMed: 28644963
DOI: 10.1016/j.msksp.2017.06.002 -
Lung Cancer (Amsterdam, Netherlands) Feb 2023Lung cancer is the principal cause of cancer-related deaths worldwide. Early detection of lung cancer with screening is indispensable to reduce the high morbidity and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lung cancer is the principal cause of cancer-related deaths worldwide. Early detection of lung cancer with screening is indispensable to reduce the high morbidity and mortality rates. Artificial intelligence (AI) is widely utilised in healthcare, including in the assessment of medical images. A growing number of reviews studied the application of AI in lung cancer screening, but no overarching meta-analysis has examined the diagnostic test accuracy (DTA) of AI-based imaging for lung cancer screening.
OBJECTIVE
To systematically review the DTA of AI-based imaging for lung cancer screening.
METHODS
PubMed, EMBASE, Cochrane Library, CINAHL, IEEE Xplore, Web of Science, ACM Digital Library, Scopus, PsycINFO, and ProQuest Dissertations and Theses were searched from inception to date. Studies that were published in English and that evaluated the performance of AI-based imaging for lung cancer screening were included. Two independent reviewers screened titles and abstracts and used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to appraise the quality of selected studies. Grading of Recommendations Assessment, Development, and Evaluation to diagnostic tests was used to assess the certainty of evidence.
RESULTS
Twenty-six studies with 150,721 imaging data were included. Hierarchical summary receiver-operating characteristic model used for meta-analysis demonstrated that the pooled sensitivity for AI-based imaging for lung cancer screening was 94.6 % (95 % CI: 91.4 % to 96.7 %) and specificity was 93.6 % (95 % CI: 88.5 % to 96.6 %). Subgroup analyses revealed that similar results were found among different types of AI, region, data source, and year of publication, but the overall quality of evidence was very low.
CONCLUSION
AI-based imaging could effectively detect lung cancer and be incorporated into lung cancer screening programs. Further high-quality DTA studies on large lung cancer screening populations are required to validate AI's role in early lung cancer detection.
Topics: Humans; Artificial Intelligence; Lung Neoplasms; Early Detection of Cancer; Diagnostic Imaging; Diagnostic Tests, Routine
PubMed: 36566582
DOI: 10.1016/j.lungcan.2022.12.002 -
Journal of Medical Internet Research Aug 2021Most colorectal polyps are diminutive and benign, especially those in the rectosigmoid colon, and the resection of these polyps is not cost-effective. Advancements in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most colorectal polyps are diminutive and benign, especially those in the rectosigmoid colon, and the resection of these polyps is not cost-effective. Advancements in image-enhanced endoscopy have improved the optical prediction of colorectal polyp histology. However, subjective interpretability and inter- and intraobserver variability prohibits widespread implementation. The number of studies on computer-aided diagnosis (CAD) is increasing; however, their small sample sizes limit statistical significance.
OBJECTIVE
This review aims to evaluate the diagnostic test accuracy of CAD models in predicting the histology of diminutive colorectal polyps by using endoscopic images.
METHODS
Core databases were searched for studies that were based on endoscopic imaging, used CAD models for the histologic diagnosis of diminutive colorectal polyps, and presented data on diagnostic performance. A systematic review and diagnostic test accuracy meta-analysis were performed.
RESULTS
Overall, 13 studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of diminutive colorectal polyps (adenomatous or neoplastic vs nonadenomatous or nonneoplastic) were 0.96 (95% CI 0.93-0.97), 0.93 (95% CI 0.91-0.95), 0.87 (95% CI 0.76-0.93), and 87 (95% CI 38-201), respectively. The meta-regression analysis showed no heterogeneity, and no publication bias was detected. Subgroup analyses showed robust results. The negative predictive value of CAD models for the diagnosis of adenomatous polyps in the rectosigmoid colon was 0.96 (95% CI 0.95-0.97), and this value exceeded the threshold of the diagnosis and leave strategy.
CONCLUSIONS
CAD models show potential for the optical histological diagnosis of diminutive colorectal polyps via the use of endoscopic images.
TRIAL REGISTRATION
PROSPERO CRD42021232189; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232189.
Topics: Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Computers; Diagnostic Tests, Routine; Humans; Narrow Band Imaging
PubMed: 34432643
DOI: 10.2196/29682 -
Scientific Reports Jul 2016Currently, an anti-glycopeptidolipid (GPL)-core IgA antibody assay kit for diagnosing Mycobacterium avium complex (MAC) is commercially available. We conducted this... (Meta-Analysis)
Meta-Analysis Review
Currently, an anti-glycopeptidolipid (GPL)-core IgA antibody assay kit for diagnosing Mycobacterium avium complex (MAC) is commercially available. We conducted this systematic review and meta-analysis to reveal the precise diagnostic accuracy of anti-GPL-core IgA antibodies for MAC pulmonary disease (MAC-PD). We systematically searched reports that could provide data for both sensitivity and specificity by anti-GPL-core IgA antibody for clinically diagnosed MAC-PD. Diagnostic test accuracy was estimated using the bivariate model. Of the 257 articles that we had found through primary search, we finally included 16 reports consisted of 1098 reference positive subjects and 2270 reference negative subjects. The diagnostic odds ratio was 24.8 (95% CI 11.6-52.8, I(2) = 5.5%) and the area under the hierarchical summary receiver operating characteristic curves was 0.873 (95% CI 0.837-0.913). With a cutoff value of 0.7 U/mL, the summary estimates of sensitivity and specificity were 0.696 (95% CI 0.621-0.761) and 0.906 (95% CI 0.836-0.951), respectively. The positive and negative likelihood ratios were 7.4 (95% CI 4.1-13.8) and 0.34 (95% CI 0.26-0.43), respectively. The demanding clinical diagnostic criteria may be a cause of false positive of the index test. The index test had good overall diagnostic accuracy and was useful to ruling in MAC-PD with the cutoff value.
Topics: Antibodies, Bacterial; Antigens, Bacterial; Diagnostic Errors; Diagnostic Tests, Routine; Glycoconjugates; Humans; Immunoglobulin A; Lung Diseases; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Predictive Value of Tests; Reference Standards; Reproducibility of Results; Sensitivity and Specificity
PubMed: 27373718
DOI: 10.1038/srep29325 -
International Journal of Colorectal... Nov 2023This study aimed to analyze the diagnostic performance of urinary 5-Hydroxyindoleacetic Acid (5-HIAA) in acute appendicitis (AA). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aimed to analyze the diagnostic performance of urinary 5-Hydroxyindoleacetic Acid (5-HIAA) in acute appendicitis (AA).
METHODS
This review was registered in PROSPERO (CRD42023399541). We included prospective or retrospective original clinical studies evaluating the diagnostic performance of 5-HIAA in AA. A search was conducted in PubMed, Web of Science, Scopus and OVID. Search terms and keywords were: (appendicitis OR acute appendicitis) AND (5-HIAA OR 5-Hydroxyindoleacetic acid OR serotonin metabolite). Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using the QUADAS2 index. A synthesis of the results, standardization of the metrics, and a random-effect meta-analysis were performed. Additionally, a coupled forest plot and a diagnostic test accuracy meta-analysis (DTA) were performed.
RESULTS
Twelve studies with data from 1467 participants (724 patients with a confirmed diagnosis of AA and 743 controls) were included in this review. The random-effect meta-analysis of urinary 5-HIAA (AA vs controls) included 7 articles (352 AA and 258 controls) and resulted in a significant mean difference [95% CI] of 23.30 [15.82-30.77] μmol/L (p < 0.001). The DTA meta-analysis of urinary 5-HIAA included 8 articles and resulted in a pooled sensitivity [95% CI] of 68.6 [44.1-85.9]% and a pooled specificity [95% CI] of 82 [54.7-94.5]%.
CONCLUSIONS
Although the evidence is heterogeneous and limited, urinary 5-HIAA emerges as a potential non-invasive diagnostic tool for AA. Urinary 5-HIAA does not seem to be a useful biomarker to distinguish between NCAA and CAA. Future prospective studies with a large sample size and a rigorous design are necessary to validate these findings.
TRIAL REGISTRATION
PROSPERO (CRD42023399541).
Topics: Humans; Appendicitis; Hydroxyindoleacetic Acid; Prospective Studies; Retrospective Studies; Acute Disease; Diagnostic Tests, Routine
PubMed: 37982905
DOI: 10.1007/s00384-023-04556-w