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Obstetrics and Gynecology Jan 2021To systematically review the performance of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in predicting adverse... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review the performance of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in predicting adverse outcomes in women with preeclampsia.
DATA SOURCES
We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, ClinicalTrials.gov, and Emcare databases from 1989 to March 2019 to identify studies correlating sFlt-1, PlGF, and the sFlt-1/PlGF ratio with the occurrence of adverse outcomes in women with preeclampsia.
METHODS OF STUDY SELECTION
Two independent reviewers screened 3,194 studies using Covidence. Studies were included if they examined the performance of sFLT-1, PlGF, or the sFLT-1/PlGF ratio in predicting adverse outcomes in women with suspected or confirmed preeclampsia.
TABULATION, INTEGRATION, AND RESULTS
We extracted contingency tables with true-positive, false-positive, true-negative, and false-negative results. We calculated sensitivity, specificity, diagnostic odds ratios, and area under the summary receiver operating characteristic curve (area sROC) through a bivariate mixed-effects meta-analysis. Our literature search identified 3,194 articles, of which 33 (n=9,426 patients) were included. There was significant variation in the included studies with regard to the biomarkers and outcomes assessed. As such, few studies (n=4-8) were included in the meta-analysis component with significant heterogeneity between studies (I2=33-99). Nonetheless, both PlGF and the sFlt-1/PlGF ratio demonstrated area sROC values between 0.68 and 0.87 for the prediction of composite adverse maternal and perinatal outcomes, preterm birth and fetal growth restriction.
CONCLUSION
Placental growth factor and the sFlt-1/PlGF ratio show prognostic promise for adverse outcomes in preeclampsia, but study heterogeneity limits their clinical utility.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42019136207.
Topics: Biomarkers; Female; Humans; Placenta Growth Factor; Pre-Eclampsia; Pregnancy; Vascular Endothelial Growth Factor Receptor-1
PubMed: 33278298
DOI: 10.1097/AOG.0000000000004149 -
Radiology Sep 2020Background Lipid-poor angiomyolipomas (AMLs) are challenging to differentiate from other renal lesions at imaging and often necessitate biopsy or surgery. If... (Meta-Analysis)
Meta-Analysis
Background Lipid-poor angiomyolipomas (AMLs) are challenging to differentiate from other renal lesions at imaging and often necessitate biopsy or surgery. If sufficiently accurate, MRI may play a role as a replacement test for biopsy. Purpose To perform a systematic review to evaluate the diagnostic performance of MRI for lipid-poor AMLs in patients with renal masses. Materials and Methods A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and the "gray literature" (conference proceedings) was performed without language restriction through July 18, 2019, with the assistance of a health sciences librarian. Original articles with more than 10 patients evaluating the diagnostic performance of MRI, with histopathologic findings used as the reference standard, for the diagnosis of lipid-poor AMLs in patients with renal masses were included. Studies including AMLs with macroscopic fat and studies with insufficient data were excluded. Patient, clinical, MRI, and diagnostic performance parameters were independently acquired by two authors. Meta-analysis was performed by using a random-effects or bivariate mixed-effects regression model depending on the number of studies. Risk of bias of individual studies was evaluated by using Quality Assessment of Diagnostic Accuracy Studies-2. Results Twenty-three studies with 2196 patients and 25 contingency tables were included. The pooled sensitivity, specificity, and area under the receiver operating characteristic curve were 83% (95% confidence interval [CI]: 72%, 90%), 90% (95% CI: 84%, 94%), and 0.93 (95% CI: 0.91, 0.95), respectively. Considerable variability was present for several variables, including MRI parameters; however, subgroup analysis did not identify MRI sequence or field strength as sources for variability. All studies were at high risk of bias for index test domain because no reported thresholds were prespecified. Conclusion MRI shows promising accuracy for detecting lipid-poor angiomyolipomas (area under the receiver operating characteristic curve, >0.9), indicating a potential role as a replacement test for biopsy in selected patients. Studies evaluating MRI accuracy with a pragmatic algorithm and prespecified threshold may be helpful to confirm this potential role in the management pathway. © RSNA, 2020
Topics: Adolescent; Adult; Aged; Angiomyolipoma; Female; Humans; Kidney; Kidney Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity; Young Adult
PubMed: 32602827
DOI: 10.1148/radiol.2020192070 -
European Radiology Jul 2020To evaluate the diagnostic test accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), whole-body magnetic resonance... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the diagnostic test accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), whole-body magnetic resonance imaging (WB-MRI), and whole-body diffusion-weighted imaging (WB-DWI) for the detection of metastases in patients with non-small cell lung cancer (NSCLC).
METHODS
MEDLINE, Embase, and Cochrane Library databases were searched up to June 2019. Studies were selected if they reported data that could be used to construct contingency tables to compare 18F-FDG PET/CT, WB-MRI, and WB-DWI. Two authors independently extracted data on study characteristics and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies. Forest plots were generated for sensitivity and specificity of 18F-FDG PET/CT, WB-MRI, and whole-body diffusion-weighted imaging (WB-DWI). Summary receiver operating characteristic plots were created.
RESULTS
The 4 studies meeting inclusion criteria had a total of 564 patients and 559 lesions, 233 of which were metastases. In studies of 18F-FDG PET/CT, the pooled estimates of sensitivity and specificity were 0.83 (95% confidence interval [CI], 0.54-0.95) and 0.93 (95% CI, 0.87-0.96), respectively. For WB-MRI, pooled sensitivity was 0.92 (95% CI, 0.18-1.00) and pooled specificity was 0.93 (95% CI, 0.85-0.95). Pooled sensitivity and specificity for WB-DWI were 0.78 (95% CI, 0.46-0.93) and 0.91 (95% CI, 0.79-0.96), respectively. There was no statistical difference between the diagnostic odds ratio of WB-MRI and WB-DWI compared with that of PET/CT (p = 0.186 for WB-DWI; p = 0.638 for WB-MRI).
CONCLUSION
WB-MRI and DWI are radiation-free alternatives with comparable diagnostic performance to 18F-FDG PET/CT for M staging of NSCLC.
KEY POINTS
• Whole-body MRI with or without diffusion-weighted imaging has a high accuracy for the diagnostic evaluation of metastases in patients with non-small cell lung cancer. • Whole-body MRI may be used as a non-invasive and radiation-free alternative to positron emission tomography with CT with similar diagnostic performance.
Topics: Carcinoma, Non-Small-Cell Lung; Diffusion Magnetic Resonance Imaging; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Whole Body Imaging
PubMed: 32125513
DOI: 10.1007/s00330-020-06703-1 -
Journal of the Belgian Society of... Jan 2020The aim of this study was to assess the diagnostic performance of F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) for...
OBJECTIVE
The aim of this study was to assess the diagnostic performance of F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) for gynecological cancers of the pelvis based on a systematic review and meta-analysis of published data.
PATIENTS AND METHODS
A systematic literature search for original diagnostic studies was performed using PubMed/MEDLINE, the Cochrane Library, Embase and Web of Science. The methodological quality of each study was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data necessary for entry in 2 × 2 contingency tables were obtained, and patients, study, and imaging characteristics were extracted from the selected articles. Statistical analysis included data pooling, heterogeneity testing, sensitivity analyses, forest plotting, and summary receiver operating characteristic curve construction.
RESULT
Twelve studies met our predefined inclusion criteria and were included in this study. Patient-based analysis, the pooled sensitivity rate, specificity rate, diagnostic odds ratio, and area under the receiver operating characteristic curve for F-FDG PET/MRI in diagnosis of gynecological malignancies were 74.2% (95% confidence interval, 66.2-80.8%), 89.8% (95% CI, 82.2-94.3%), 26 (95% CI, 10-67), and 0.834, respectively. On lesion-based analysis, the pooled sensitivity rate, specificity rate, diagnostic odds ratio, and area under the curve were 87.5% (95% CI, 75.8-94.0%), 88.2% (95% CI, 84.2-91.3%), 50 (95% CI, 23-111), and 0.922, respectively.
CONCLUSIONS
Our meta-analysis demonstrated that F-FDG PET/MRI is a promising diagnostic method for primary tumors, nodal staging, and recurrence in patients with gynecological malignancies of the pelvis.
PubMed: 31998862
DOI: 10.5334/jbsr.1981 -
Hip International : the Journal of... Nov 2020The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can...
BACKGROUND
The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA.
METHODS
The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted.
RESULTS
Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table ( = 4402) and 100.1 ± 32.6 minutes for traction table ( = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard ( = 2992) and 531.7 ± 364.3 mL for traction table ( = 2675). Intra-operative fracture rate was 1.3% for standard table ( = 3940) and 1.7% for traction table ( = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies.
CONCLUSION
Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Joint Dislocations; Operative Time
PubMed: 31994425
DOI: 10.1177/1120700019900987 -
The British Journal of Radiology Dec 2019To evaluate the diagnostic accuracy of multiparametric MRI (mpMRI) for detecting extracapsular extension (ECE) in patients with prostate cancer (PCa). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the diagnostic accuracy of multiparametric MRI (mpMRI) for detecting extracapsular extension (ECE) in patients with prostate cancer (PCa).
METHODS AND MATERIALS
We searched MEDLINE, PubMed, Embase and the Cochrane library up to December 2018. We included studies that used mpMRI to differentiate ECE from organ-confined PCa with a combination of weighted imaging (WI), diffusion-weighted imaging, and dynamic contrast-enhanced MRI. All studies included had pathological diagnosis with radical prostatectomy. Two reviewers independently assessed the methodological quality of included studies by using Quality Assessment of Diagnostic Accuracy Studies 2 tool. We calculated pooled sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios and receiver operating characteristic curve for mpMRI from 2 × 2 tables.
RESULTS
A total of 17 studies that comprised 3374 participants were included. The pooled data showed a sensitivity of 0.55 (95% confidence interval 0.43, 0.66]) and specificity of 0.87 (95% confidence interval 0.82, 0.91) for extracapsular extension detection in PCa.
CONCLUSION
First, our meta-analysis shows moderate sensitivity and high specificity for mpMRI to differentiate ECE from organ-confined prostate cancer before surgery. Second, our meta-analysis shows that mpMRI had no significant differences in performance compared with the former meta-analysis with use of WI alone or with additional functional MRI.
ADVANCES IN KNOWLEDGE
It is the first meta-analysis to evaluate the accuracy of mpMRI in combination of WI, diffusion-weightedimaging and dynamiccontrast-enhanced-MRI for extracapsular extension detection.
Topics: Confidence Intervals; Contrast Media; Diffusion Magnetic Resonance Imaging; Humans; Magnetic Resonance Imaging; Male; Preoperative Care; Prostate; Prostatectomy; Prostatic Neoplasms; ROC Curve; Sensitivity and Specificity
PubMed: 31596123
DOI: 10.1259/bjr.20190480 -
The Cochrane Database of Systematic... Jul 2019Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, possibly associated with an increased risk of severe fetal adverse events. Total serum bile...
BACKGROUND
Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, possibly associated with an increased risk of severe fetal adverse events. Total serum bile acids (TSBA) concentration, alone or in combination with serum aminotransferases, have been the most often used biomarkers for the diagnosis of intrahepatic cholestasis of pregnancy in clinical practice. Serum bile acid profile, composed of primary or secondary, conjugated or non-conjugated bile acids, may provide more specific disease information.
OBJECTIVES
To assess and compare, independently or in combination, the diagnostic accuracy of total serum bile acids or serum bile acids profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women, presenting with pruritus. To define the optimal cut-off values for components of serum bile acid profile; to investigate possible sources of heterogeneity.
SEARCH METHODS
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register, the Cochrane Library, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, BIOSIS, CINAHL, two Chinese databases (CKNI, VIP), Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Evidence Search: Health and Social Care by the National Institute for Health and Care Excellence (NICE), the World Health Organization (WHO) Reproductive Health Library (RHL), and the Turning Research into Practice database (TRIP). The most recent date of search was 6 May 2019. We identified additional references by handsearching the references of articles, meta-analyses, and evidence-based guidelines retrieved from the computerised databases, on-line trial registries, and grey literature through OpenSIGLE, National Technical Information Service (NTIS), ProQuest Dissertations & Thesis Database, and Index to Theses in Great Britain and Ireland.
SELECTION CRITERIA
Prospective or retrospective diagnostic case-control or cross-sectional studies, irrespective of publication date, format, and language, which evaluated the diagnostic accuracy of total serum bile acids (TSBA) or components of serum bile acid profile for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women of any age or ethnicity, in any clinical setting, symptomatic for pruritus.
DATA COLLECTION AND ANALYSIS
We selected studies by reading titles, abstracts, or full texts, and assessing their fulfilment of our inclusion criteria. We emailed primary authors to request missing data or individual participant data. Having extracted data from each included study, we built the two-by-two tables for each primary study and for all the index tests considered. We estimated sensitivity and specificity with their 95% confidence intervals (CI). We presented data in coupled forest plots, showing sensitivities and specificities of each study, and we plotted the studies in the Receiver Operating Characteristic (ROC) space. We performed meta-analyses adopting the hierarchical summary ROC model (HSROC) or the bivariate model to meta-analyse the data. We made indirect comparisons of the considered index tests by adding the index tests as covariates to the bivariate or HSROC models. We performed heterogeneity analysis and sensitivity analysis on studies assessing TSBA accuracy. We used Review Manager 5 (RevMan 5) and SAS statistical software, release 9.4 (SAS Institute Inc., Cary, NC, USA), to perform all statistical analyses. We used QUADAS-2 domains to assess the risk of bias of the included studies.
MAIN RESULTS
Our search yielded 5073 references, but at the end of our selection process, only 16 studies fulfilled the review inclusion criteria. Nine of these provided individual participant data. We analysed only data concerning TSBA, cholic acid (CA), glycocholic acid (GCA), chenodeoxycholic acid (CDCA), and CA/CDCA because the remaining planned index tests were assessed in few studies. Only one study had low risk of bias in all four QUADAS-2 domains. The most biased domains were the patient sampling and the reference standard domains. When considering all studies with a cut-off of 10 μmol/L, TSBA overall sensitivity ranged from 0.72 to 0.98 and specificity ranged from 0.81 to 0.97. After a sensitivity analysis excluding case-control studies, TSBA sensitivity ranged from 0.48 to 0.66 and specificity from 0.52 to 0.99. After a sensitivity analysis excluding studies in which TSBA was part of the reference standard, TSBA sensitivity ranged from 0.49 to 0.65 and specificity from 0.53 to 0.99. We found the estimates of the overall accuracy for some serum bile acid components (CA, GCA, CDCA, and CA/CDCA) to be imprecise, with the CI for sensitivity and specificity very wide or impossible to calculate. Indirect comparisons between serum bile acid profile components and TSBA were not statistically significant. None of the heterogeneity analysis performed was statistically significant, except for the timing of assessment of TSBA (onset of symptoms, peak value among multiple assessments, delivery) but without clinically relevant results. We could not analyse the diagnostic accuracy of combinations of index tests because none of the included studies carried them out, and because of the small number of included studies.
AUTHORS' CONCLUSIONS
The overall high risk of bias, the existing concern regarding applicability of the results in clinical practice, and the great heterogeneity of the results in the included studies prevents us from making recommendations and reaching definitive conclusions at the present time. Thus, we do not find any compelling evidence to recommend or refute the routine use of any of these tests in clinical practice. So far, the diagnostic accuracy of TSBA for intrahepatic cholestasis of pregnancy might have been overestimated. There were too few studies to permit a precise estimate of the accuracy of serum bile acid profile components. Further primary clinical research is mandatory. We need both further phase II and phase III diagnostic studies.
Topics: Bile Acids and Salts; Biomarkers; Cholestasis, Intrahepatic; Diagnostic Tests, Routine; Female; Humans; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic
PubMed: 31283001
DOI: 10.1002/14651858.CD012546.pub2