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Respiration; International Review of... 2020Obtaining a tissue diagnosis of centrally located lung tumors in patients presenting without endobronchial abnormalities is challenging, and therefore a considerable... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Obtaining a tissue diagnosis of centrally located lung tumors in patients presenting without endobronchial abnormalities is challenging, and therefore a considerable diagnostic problem.
OBJECTIVE
The objective of this study was to evaluate the performance of linear endobronchial ultrasound guided-transbronchial-needle aspiration (EBUS-TBNA) for the diagnosis of centrally located lung tumors.
METHODS
We performed a systematic review (PROSPERO, CRD42017080968) and searched MEDLINE, Embase, BIOSIS Previews, and Web of Science till November 18, 2018 for studies that evaluated the yield and/or sensitivity of EBUS-TBNA for diagnosing centrally located lung tumors. We assessed the study quality using QUADAS-2 and performed random-effects meta-analysis.
RESULTS
A total of 5,657 manuscripts were identified; of these 14 were considered for the study, including 1,175 patients who underwent EBUS-TBNA for diagnosing an intrapulmonary tumor. All studies had a high risk of bias or applicability concerns, predominately regarding patient selection. The average yield of EBUS-TBNA for diagnosing centrally located lung tumors was 0.89 (95% CI 0.84-0.92) and average sensitivity for diagnosing malignant tumors was 0.91 (95% CI 0.88-0.94). Among studies reporting this information, EBUS-related complications occurred in 5.4% of patients (42/721).
CONCLUSION
EBUS-TBNA has a high yield and sensitivity for diagnosing centrally located lung tumors and is safe in selected patients. Prospective studies are recommended to evaluate the routine use of this procedure for diagnosing intrapulmonary tumors.
Topics: Biopsy, Needle; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Image-Guided Biopsy; Lung Neoplasms; Sensitivity and Specificity
PubMed: 31734666
DOI: 10.1159/000500363 -
Acta Obstetricia Et Gynecologica... Aug 2021Frozen section diagnoses of borderline ovarian tumors are not always straightforward and a borderline frozen section diagnosis with suspicious features of invasive... (Meta-Analysis)
Meta-Analysis
Frozen section diagnosis of borderline ovarian tumors with suspicious features of invasive cancer is a devil's dilemma for the surgeon: A systematic review and meta-analysis.
INTRODUCTION
Frozen section diagnoses of borderline ovarian tumors are not always straightforward and a borderline frozen section diagnosis with suspicious features of invasive carcinoma (reported as "at least borderline" or synonymous descriptions) presents us with the dilemma of whether or not to perform a full surgical staging procedure. By performing a systematic review and meta-analysis, the prevalence of straightforward borderline and "at least borderline" frozen section diagnoses, as well as proportion of patients with a final diagnosis of invasive carcinoma in these cases, were assessed and compared, as quantification of this dilemma may help us with the issue of this clinical decision.
MATERIAL AND METHODS
PubMed, EMBASE and Cochrane library databases were searched and studies discussing "at least borderline" frozen section diagnoses were included in the review. Numbers of specific frozen section diagnoses and subsequent final histological diagnoses were extracted and pooled analysis was performed to compare the proportion of patients diagnosed with invasive carcinoma following borderline and "at least borderline" frozen section diagnoses, presented as risk ratio and risk difference with 95% confidence intervals (95% CI).
RESULTS
Of 4940 screened records, eight studies were considered eligible for quantitative analysis. A total of 921 women was identified and 230 (25.0%) of these women were diagnosed with "at least borderline" ovarian tumor at the time of frozen section. Final histological diagnoses were reported in five studies, including 61 women with an "at least borderline" diagnosis and 290 women with a straightforward borderline frozen section diagnosis. Twenty-five of 61 women (41.0%) of the "at least borderline" group had invasive cancer at final diagnosis, compared with 28 of 290 women (9.7%) of the straightforward borderline frozen section group (risk difference -0.34, 95% CI -0.53 to -0.15; relative risk 0.25, 95% CI 0.13-0.50).
CONCLUSIONS
Women diagnosed with "at least borderline" frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis when compared with women with a straightforward borderline frozen section diagnosis (41.0% vs 9.7%). Especially in the serous subtype, and after preoperative consent, full staging during initial surgery might be considered in these cases to prevent a second surgical procedure.
Topics: Female; Frozen Sections; Humans; Neoplasm Invasiveness; Ovarian Neoplasms
PubMed: 33539545
DOI: 10.1111/aogs.14105 -
Parasite (Paris, France) 2023Serological methods should meet the needs of leishmaniasis diagnosis due to their high sensitivity and specificity, economical and adaptable rapid diagnostic test...
Serological methods should meet the needs of leishmaniasis diagnosis due to their high sensitivity and specificity, economical and adaptable rapid diagnostic test format, and ease of use. Currently, the performances of serological diagnostic tests, despite improvements with recombinant proteins, vary greatly depending on the clinical form of leishmaniasis and the endemic area. Peptide-based serological tests are promising as they could compensate for antigenic variability and improve performance, independently of Leishmania species and subspecies circulating in the endemic areas. The objective of this systematic review was to inventory all studies published from 2002 to 2022 that evaluate synthetic peptides for serological diagnosis of human leishmaniases and also to highlight the performance (e.g., sensitivity and specificity) of each peptide reported in these studies. All clinical forms of leishmaniasis, visceral and tegumentary, and all Leishmania species responsible for these diseases were considered. Following PRISMA statement recommendations, 1,405 studies were identified but only 22 articles met the selection criteria and were included in this systematic review. These original research articles described 77 different peptides, of which several have promising performance for visceral or tegumentary leishmaniasis diagnosis. This review highlights the importance of and growing interest in synthetic peptides used for serological diagnosis of leishmaniases, and their performances compared to some widely used tests with recombinant proteins.
Topics: Humans; Animals; Dogs; Leishmaniasis, Visceral; Leishmania; Serologic Tests; Leishmaniasis; Peptides; Sensitivity and Specificity; Leishmaniasis, Cutaneous; Recombinant Proteins; Antigens, Protozoan; Enzyme-Linked Immunosorbent Assay; Dog Diseases
PubMed: 37010451
DOI: 10.1051/parasite/2023011 -
The American Journal of Emergency... Mar 2023Necrotizing fasciitis (NF) is a deadly disorder that can be challenging to diagnose on history and examination alone. Point-of-care ultrasound (POCUS) is widely... (Review)
Review
BACKGROUND
Necrotizing fasciitis (NF) is a deadly disorder that can be challenging to diagnose on history and examination alone. Point-of-care ultrasound (POCUS) is widely available and has been increasingly used for diagnosing skin and soft tissue infections. We performed a systematic review to determine the accuracy of POCUS for diagnosing NF with subgroup analyses of the accuracy of specific POCUS examination components.
METHODS
PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles were assessed for all retrospective, prospective, and randomized control trials evaluating the accuracy of POCUS for diagnosing NF. Data were dual extracted into a predefined worksheet and quality analysis was performed with the QUADAS-2 tool. Data were summarized and an overall summary was completed.
RESULTS
We identified three papers (n = 221 patients; 33% NF) that met our inclusion criteria. The overall sensitivity ranged from 85.4%-100% while the specificity ranged from 44.7% to 98.2%. Fluid accumulation along the fascial plane was the most sensitive (85.4%; 95% CI 72.2% - 93.9%), while subcutaneous emphysema was the most specific (100%; 95% CI 92.5% - 100%).
CONCLUSIONS
POCUS has good sensitivity and specificity for the diagnosis of NF. POCUS should be considered as an adjunct to the initial clinical decision making for the diagnosis of NF.
Topics: Humans; Point-of-Care Systems; Fasciitis, Necrotizing; Retrospective Studies; Prospective Studies; Emergency Service, Hospital; Sensitivity and Specificity; Ultrasonography
PubMed: 36580698
DOI: 10.1016/j.ajem.2022.12.037 -
Journal of Endovascular Therapy : An... Aug 2014To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To quantitatively summarize the incidence of misdiagnosis of ruptured abdominal aortic aneurysms (rAAA), the most common presenting features, and the commonest incorrect differential diagnoses.
METHODS
A systematic search according to PRISMA guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting the initial rate of misdiagnosis of patients with rAAA. Random-effects meta-analyses were performed to estimate the rate of misdiagnosis, presenting features, and commonest differential diagnoses. A sensitivity analysis was performed for studies reporting after 1990.
RESULTS
Nine studies comprising 1109 patients contributed to the pooled analysis, which found a 42% incidence of rAAA misdiagnosis (95% CI 29% to 55%). In studies reporting after 1990, misdiagnosis was seen in 32% (95% CI 16% to 49%). The most common erroneous differential diagnoses were ureteric colic and myocardial infarction. Abdominal pain, shock, and a pulsatile mass were presenting features in 61% (49%-72%), 46% (32%-61%), and 45% (29%-62%) of rAAAs, respectively.
CONCLUSION
The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Diagnosis, Differential; Diagnostic Errors; Humans; Predictive Value of Tests; Prognosis
PubMed: 25101588
DOI: 10.1583/13-4626MR.1 -
Annals of Palliative Medicine Aug 2021Few studies comprehensively compared the performance of magnetic resonance elastography (MRE) and transient elastography (TE) in the diagnosis of liver fibrosis.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Few studies comprehensively compared the performance of magnetic resonance elastography (MRE) and transient elastography (TE) in the diagnosis of liver fibrosis. Therefore, we conducted a meta-analysis to evaluate and compare the diagnostic efficacy of these 2 techniques in patients with hepatic fibrosis in order to gain a better understanding of their overall diagnostic performance and aid in maximizing their clinical utility.
METHODS
Systematic literature searches of the PubMed, EmBase, Cocharane Library, and China National Knowledge Infrastructure databases were carried out to identify studies that applied MRE and TE in the diagnosis of liver fibrosis. The combined sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (ORs) were estimated using a bivariate random effects model. Review Manager 5.2 was used to analyze the selected articles, and forest plot, sensitivity, and bias analyses were performed for the included literature. To determine the diagnostic efficacy of MRE and TE for liver fibrosis, pooled sensitivity and specificity analyses were conducted.
RESULTS
Eight studies met the inclusion criteria. In the diagnosis of stage F0-F1 liver fibrosis, MRE showed higher sensitivity than TE (OR =0.62, 95% CI: 0.41-0.95, P=0.03). MRE also showed higher specificity than TE for diagnosing stage F2-F4 liver fibrosis (OR =0.41, 95% CI: 0.27-0.62, P<0.0001). There was no difference in the sensitivity of MRE and Te to F2-F4 hepatic fibrosis and the specificity of MRE and Te to F0-F1 hepatic fibrosis.
CONCLUSIONS
In terms of sensitivity and specificity, MRE is superior to TE in diagnosing different stages of liver fibrosis to a certain extent. MRE may be a useful, noninvasive method for the assessment of liver fibrosis in patients with chronic liver disease.
Topics: Databases, Factual; Elasticity Imaging Techniques; Humans; Liver Cirrhosis; Research Design; Sensitivity and Specificity
PubMed: 34488358
DOI: 10.21037/apm-21-1176 -
International Journal of Gynaecology... Jul 2023To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses. (Review)
Review
OBJECTIVE
To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses.
METHODS
A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed.
RESULTS
Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05).
CONCLUSION
The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks.
Topics: Pregnancy; Humans; Female; Cesarean Section; Uterine Diseases; Uterus; Pregnancy Complications; Early Diagnosis
PubMed: 36495234
DOI: 10.1002/ijgo.14615 -
Scandinavian Journal of Gastroenterology Jul 2014The lack of pathognomonic findings and the chance of complicated disease have resulted in the widespread use of additional imaging to diagnose acute colonic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The lack of pathognomonic findings and the chance of complicated disease have resulted in the widespread use of additional imaging to diagnose acute colonic diverticulitis (ACD). The added value of additional imaging in the diagnostic workup of patients suspected of ACD is not well defined.
AIMS
The aim of this study was to systematically review the literature of the accuracy of the clinical evaluation and diagnostic modalities for patients with suspected ACD, to come to an evidence-based approach to diagnose ACD.
METHODS
A systematic review and meta-analysis of studies that reported diagnostic accuracy of the clinical diagnosis and diagnostic modalities in patients with suspected diverticulitis were performed. Study quality was assessed with the STARD checklist. True-positive, true-negative, false-positive, and false-negative findings were extracted and pooled estimates of sensitivity and specificity per diagnostic test were calculated, if applicable.
RESULTS
The overall quality of the studies reporting the diagnostic accuracy of the clinical diagnosis, contrast enema and magnetic resonance imaging (MRI) were moderate to poor and not suitable for meta-analysis. Sensitivity of the clinical diagnosis varied between 64% and 68%. Ultrasound (US) and computed tomography (CT) studies were eligible for meta-analysis. Summary sensitivity estimates for US were 90% (95% CI: 76-98%) versus 95% (95% CI: 91-97%) for CT (p = 0.86). Summary specificity estimates for US were 90% (95% CI: 86-94%) versus 96% (95% CI: 90-100%) for CT (p = 0.04). Sensitivity for MRI was 98% and specificity varied between 70% and 78%. Sensitivity of contrast enema studies varied between 80% and 83%.
CONCLUSION
In two-thirds of the patients, the diagnosis of ACD can be made based on clinical evaluation alone. In one-third of the patients, additional imaging is a necessity to establish the diagnosis. US and CT are comparable in diagnosing diverticulitis and superior to other modalities. CT has the advantage of higher specificity and the ability to identify alternative diagnoses. The role of MRI is not yet clear in diagnosing ACD. Contrast enema is considered an obsolete imaging technique to diagnose ACD based on lower sensitivity and specificity than US and CT. A step-up approach with CT performed after an inconclusive or negative US, seems a logical and safe approach for patients suspected of ACD.
Topics: Acute Disease; Diverticulitis, Colonic; Evidence-Based Medicine; False Negative Reactions; False Positive Reactions; Humans; Magnetic Resonance Imaging; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography
PubMed: 24874087
DOI: 10.3109/00365521.2014.908475 -
Orthopaedic Journal of Sports Medicine May 2017Femoroacetabular impingement (FAI) is a well-recognized condition that causes hip pain and can lead to early osteoarthritis if not managed properly. With the increasing... (Review)
Review
BACKGROUND
Femoroacetabular impingement (FAI) is a well-recognized condition that causes hip pain and can lead to early osteoarthritis if not managed properly. With the increasing awareness and efficacy of operative treatments for pincer-type FAI, there is a need for consensus on the standardized radiographic diagnosis.
PURPOSE
To perform a systematic review of the evidence regarding imaging modalities and radiographic signs for diagnosing pincer-type FAI.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A literature review was performed in 2016 using the Cochrane, PubMed, and Embase search engines. All articles focusing on a radiographic diagnosis of pincer-type FAI were reviewed. Each of the included 44 articles was assigned the appropriate level of evidence, and the particular radiographic marker and/or type of imaging were also summarized.
RESULTS
There were 44 studies included in the final review. Most of the articles were level 4 evidence (26 articles), and there were 12 level 3 and 6 level 2 articles. The crossover sign was the most commonly used radiographic sign (27/44) followed by the lateral center-edge angle (22/44). Anteroposterior (AP) pelvis plain radiographs were the most commonly used imaging modality (33 studies). Poor-quality evidence exists in support of most currently used radiographic markers, including the crossover sign, lateral center-edge angle, posterior wall sign, ischial spine sign, coxa profunda, acetabular protrusion, and acetabular index. There is poor-quality conflicting evidence regarding the use of the herniation pit to diagnose pincer-type FAI. Some novel measurements, such as β-angle, acetabular roof ratio, and acetabular retroversion index, have been proposed, but they also lack support from the literature.
CONCLUSION
No strong evidence exists to support a single best set of current radiographic markers for the diagnosis of pincer-type FAI, largely due to the lack of better quality trials (levels 1 and 2) that compare conventional radiographic findings with the gold standard, which is the intraoperative findings. More sophisticated imaging modalities such as computed tomography and magnetic resonance arthrography are often needed to diagnose pincer-type FAI, and these investigations are relatively accurate in assessing labral pathology or cartilage damage.
PubMed: 28607941
DOI: 10.1177/2325967117708307 -
Thyroid : Official Journal of the... May 2015Thyroid nodules are a common finding in the general population, and their detection is increasing with the widespread use of ultrasound (US). Thyroid cancer is found in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thyroid nodules are a common finding in the general population, and their detection is increasing with the widespread use of ultrasound (US). Thyroid cancer is found in 5-15% of cases depending on sex, age, and exposure to other risk factors. Some US parameters have been associated with increased risk of malignancy. However, no characteristic seems sufficiently reliable in isolation to diagnose malignancy. The objective of this meta-analysis was to evaluate the diagnostic performance of US features for thyroid malignancy in patients with unselected thyroid nodules and nodules with indeterminate fine-needle aspiration (FNA) cytology.
METHODS
Electronic databases were reviewed for studies published prior to July 2012 that evaluated US features of thyroid nodules and reported postoperative histopathologic diagnosis. A manual search of references of review and key articles, and previous meta-analyses was also performed. A separate meta-analysis was performed including only nodules with indeterminate cytology. Analyzed features were solid structure, hypoechogenicity, irregular margins, absence of halo, microcalcifications, central vascularization, solitary nodule, heterogeneity, taller than wide shape, and absence of elasticity.
RESULTS
Fifty-two observational studies (12,786 nodules) were included. Nine studies included nodules with indeterminate cytology as a separate category, comprising 1851 nodules. In unselected nodules, all US features were significantly associated with malignancy with an odds ratio varying from 1.78 to 35.7, and microcalcifications, irregular margins, and a taller than wide shape had high specificities (Sp; 87.8%, 83.1%, 96.6%) and positive likelihood ratios (LHR; 3.26, 2.99, 8.07). Absence of elasticity was the single feature with the best diagnostic performance (sensitivity 87.9%, Sp 86.2%, and positive LHR 6.39). The presence of central vascularization was the most specific US feature in nodules with indeterminate cytology (Sp 96% and positive LHR 2.13).
CONCLUSIONS
US features in isolation do not provide reliable information to select nodules that should have a FNA performed. A combination of US characteristics with higher likelihood ratios and consequently with higher post-test probabilities of malignancy-microcalcifications, or a taller than wide shape, or irregular margins, or absence of elasticity-will probably identify nodules with an increased risk for malignancy. Further studies are required to standardize elastography techniques and evaluate outcomes, especially in nodules with an indeterminate cytology.
Topics: Carcinoma; Diagnosis, Differential; Humans; Risk; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography
PubMed: 25747526
DOI: 10.1089/thy.2014.0353