Bivariate Random-effects Model Research Articles

Diagnostic performance of microRNAs for predicting response to transarterial chemoembolization in hepatocellular carcinoma: a meta-analysis

PurposeTo provide a detailed pooled analysis of the diagnostic accuracy of microRNAs (miRNAs) in predicting the response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).MethodsA comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science to identify studies assessing the diagnostic performance of miRNAs in predicting TACE response in HCC. Two independent reviewers performed quality assessment and data extraction using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression were performed to explore potential sources of heterogeneity, including sample size, response criteria, specimen source, response evaluation methods, TACE efficacy interval window, and geographical location.ResultsSeven studies, comprising 320 HCC responders and 187 non-responders, were included in this meta-analysis. The miRNAs studied included miR-373, miR-210, miR-4492, miR-1271, miR-214, miR-133b, and miR-335. The pooled sensitivity of miRNAs in predicting recurrence after TACE was 0.79 [95% CI: 0.72-0.84], and the pooled specificity was 0.82 [95% CI: 0.74-0.88]. The DOR was 17 [95% CI: 9-33], and the pooled area under the SROC curve (AUC) was 0.85 [95% CI: 0.81-0.88], indicating excellent diagnostic accuracy. Subgroup analyses revealed significant differences in diagnostic performance based on response criteria and geographical location. Meta-regression did not identify any significant sources of interstudy heterogeneity.ConclusionMiRNAs show promise as diagnostic tools for predicting TACE response in HCC patients. However, their clinical application requires further validation in larger cohorts. Future research should focus on standardizing RNA extraction methods, selecting consistent endogenous controls, and adopting uniform response evaluation criteria to improve reliability and reduce variability.

Diagnostic Accuracy of Microbiome-Derived Biomarkers in Periodontitis: Systematic Review and Meta-Analysis.

To evaluate the diagnostic accuracy of microbiome-derived biomarkers for periodontitis in oral fluids (saliva and subgingival samples). This systematic review followed PRISMA guidelines. Electronic searches were performed across multiple databases from December 2022 to November 2024. Subgroup analyses, divided into saliva and subgingival samples, were performed using the Random Effects Model (REM), while individual biomarker sensitivity and specificity were evaluated through the Bivariate Random-Effects Model (BREM). Ten studies were included, stratified by sample type. In the saliva group, Porphyromonas gingivalis, Tannerella forsythia and Prevotella intermedia demonstrated the highest diagnostic accuracy, with sensitivities reaching 89.2%, 89.2% and 86.5%, and specificities of 94.6%, 86.5% and 83.8%, respectively, achieving AUC values above 0.80. Porphyromonas gingivalis was further analysed using BREM, with the Summary Receiver Operating Characteristic (SROC) curve indicating a combined sensitivity and specificity of 84.2% and 85.4%, with an AUC of 0.864. In the subgingival group, biomarkers such as endotoxin activity and combined bacterial biomarkers (5 bacterial species) displayed the highest diagnostic performance, with sensitivities of 90.6% and 85.1% and specificities of 87.9% and 100%, respectively, and AUC values of 0.93 and 0.88. Microbiome-derived biomarkers show good clinical utility for improving diagnoses of periodontitis, offering high specificity and sensitivity. Future research should focus on standardising methodologies, increasing sample sizes, and including diverse populations to validate these findings, thereby improving diagnostic precision and facilitating the screening methods for the onset of periodontitis and dysbiotic activity.

Patency Capsule and Cross-Sectional Imaging for Predicting Capsule Endoscopy Retention: A Systematic Review and Meta-Analysis.

Small bowel capsule endoscopy, which has been widely used to evaluate small bowel disease, has a risk of capsule retention (CR). The present systematic review and meta-analysis evaluated the accuracy of patency capsule (PC) and cross-sectional imaging (CSI) for predicting CR. Databases, including MEDLINE/PubMed, EMBASE, Web of Science and the Cochrane library, were searched for articles through August 15, 2023, that investigated the diagnostic accuracy of PC or CSI for predicting CR. Pooled sensitivity and specificity were calculated using a bivariate random-effects model. The false-negative rates of PC and CSI were separately analyzed and compared using a single-proportion meta-analysis based on random-effects modeling. Twenty-three articles (covering 3273 patients) including 17 assessing PC (involving 3051 patients), 4 assessing CSI (involving 140 patients), and 2 assessing both PC and CSI (involving 82 patients) were identified. CSI had a pooled sensitivity and specificity for predicting CR of 54% (95% confidence interval [CI], 21-84%) and 88% (95% CI, 67-97%), respectively, whereas PC had a pooled sensitivity and specificity for predicting CR of 75% (95% CI, 43-92%) and 94% (95% CI, 90-96%), respectively. PC showed a significantly higher specificity (P = 0.05) and lower pooled false-negative rate than CSI (2.7% [95% CI, 1.3-5.4%] vs. 12.8% [95% CI, 6.1-25.0%]; P = 0.001). PC showed demonstrated comparable sensitivity, significantly higher specificity, and significantly lower false-negative rate than CSI. PC may be a more reliable modality for predicting CR than CSI.

Diagnostic accuracy of two-dimensional shear wave elastography and point shear wave elastography in identifying different stages of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease: A meta-analysis

To assess the diagnostic accuracy of two-dimensional shear wave elastography (2-D SWE) and point shear wave elastography (pSWE) in detecting liver fibrosis stages in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), a comprehensive search was conducted across four databases up to February 9, 2024. A bivariate random-effects model was used to analyze the diagnostic accuracy of the methods. After screening, thirteen studies involving pSWE included 1,527 patients, while nine studies involving 2-D SWE included 1,088 patients. The areas under the summary receiver operating characteristic (SROC) curves for diagnosing significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F=4) using pSWE and 2-D SWE were as follows: 0.84 (95% CI 0.80-0.87), 0.91 (95% CI 0.88-0.93), and 0.94 (95% CI 0.91-0.95) for pSWE; 0.83 (95% CI 0.79-0.86) 0.85 (95% CI 0.82-0.88), and 0.89 (95% CI 0.86-0.91) for 2-D SWE, respectively. The pooled sensitivity for pSWE and 2-D SWE for stages F≥2, F≥3, and F=4 were 0.71 (95% CI 0.63-0.78), 0.81 (95% CI 0.72-0.88), and 0.81 (95% CI 0.63-0.91) for pSWE, and 0.77 (95% CI 0.68-0.84), 0.80 (95% CI 0.72-0.87), and 0.92 (95% CI 0.75-0.98) for 2-D SWE, respectively. The pooled specificity of pSWE and 2-D SWE for these stages were 0.83 (95% CI 0.76-0.88), 0.87 (95% Cl: 0.81-0.92), and 0.91 (95% CI 0.86-0.94) for pSWE, and 0.76 (95% CI 0.66-0.84), 0.76 (95% CI 0.69-0.82), and 0.83 (95% CI 0.78-0.85) for 2-D SWE, respectively. In conclusion, both 2-D SWE and pSWE demonstrated high diagnostic performance in identifying various stages of liver fibrosis in MASLD patients.

The diagnostic performance of phase angle for sarcopenia among older adults: A systematic review and diagnostic meta-analysis.

Phase angle is a promising tool for diagnosing sarcopenia. This study aimed to summarize its diagnostic performance by performing a systematic review and meta-analysis. We conducted a systematic search of PubMed, Web of Science, Embase, and Scopus. The Quality Assessment of Diagnostic Accuracy Studies, Version 2, was used to evaluate the quality of the studies. A bivariate random effects model was employed for data synthesis, and diagnostic performance was reported in terms of pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve (AUC). Additionally, meta-regression, subgroup analyses, and sensitivity analyses were performed. A total of 15 studies were included in this meta-analysis, involving 4,063 participants. The overall risk of bias in the included studies was high. The meta-analysis revealed that the pooled sensitivity and specificity across all studies were 0.74 [95 % confidence interval (CI): 0.71-0.78] and 0.75 (95 % CI: 0.70-0.79), respectively, with an AUC of 0.79 (95 % CI: 0.76-0.83). Meta-regression indicated that study design, country, population, sex-specificity, and age may influence the diagnostic performance of phase angle. The optimal diagnostic performance was observed in the cut-off interval of 4.20 to 4.50°. The phase angle demonstrated moderate diagnostic performance for sarcopenia, and the possible cut-off interval is 4.20 to 4.50 °. However, large-scale, multicenter prospective studies are necessary to assess its clinical applicability at specific cut-off values.

Comparing the Diagnostic Performance of Ultrasound Elastography and Magnetic Resonance Imaging to Differentiate Benign and Malignant Breast Lesions: A Systematic Review and Meta-analysis.

The purpose of this systematic review and meta-analysis was comparing diagnostic performance of ultrasound elastography (UE), strain UE and shear wave elastography (SWE), with magnetic resonance imaging (MRI) in differentiating benign and malignant breast lesions. Literature search of MEDLINE, Web of Science, SCOPUS and Google Scholar was performed in June 2023. Included studies used Breast Imaging Reporting and Data System (BI-RADS) and histopathology as reference standard. A bivariate random-effects model was used to calculate sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios and area under the curve (AUC). Meta-regression subgroup analysis was performed. Nine studies and 536 lesions were included. Pooled sensitivity was not different between MRI vs UE [MRI: 94% (95% CI: 88.2%-96.9%) vs UE: 90% (95% CI: 84.7%-93.1%); P=0.153] but a difference was found for specificity [UE: 78% (95% CI: 66.3%-86.4%) vs MRI: 71.3% (95% CI: 52.1%-85%); P=0.0065]. Strain UE showed higher specificity and similar sensitivity to SWE [strain UE: 0.85 (95% CI: 0.71-0.93) vs SWE: 0.72 (95% 0.58-0.83); P=0.017 and strain UE: 0.87 (95% CI 0.79-0.93) vs SWE: 0.91 (95% CI 0.85-0.95); P=0.311, respectively]. AUC was similar between MRI vs UE [0.91 (95% CI 0.87-0.95) vs 0.92 (95% CI 0.88-0.95); P=0.452, respectively] as was DOR [MRI: 38.083 (95% CI: 12.401-116.957) vs UE: 30.395 (95% CI: 16.572-55.75); P>0.05]. Meta-regression analysis found no significant differences in the diagnostic accuracy between MRI, strain UE and SWE. Our results show that UE when compared to MRI has adequate performance in differentiating benign and malignant breast lesions.

Diagnostic accuracy of Agile-4 score for liver cirrhosis in patients with metabolic dysfunction-associated steatotic liver disease. A systematic review and meta-analysis of diagnostic test accuracy studies.

A novel noninvasive score, Agile-4 score, combining liver stiffness measurements, aspartate aminotransferase/alanine aminotransferase, platelet count, diabetes status and sex has been developed for the identification of cirrhosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We assessed the performance of Agile-4 for ruling-in/out liver cirrhosis in MASLD patients. We searched Medline, Cochrane library, Web of science, Scopus and Echosens website up to May 2024. Eligible studies assessed the accuracy of Agile-4 for ruling-in (≥0.565) and ruling-out (<0.251) liver cirrhosis, using biopsy as the reference standard, at predefined thresholds. We calculated pooled sensitivity and specificity estimates for both Agile-4 thresholds alongside 95% confidence intervals following bivariate random-effect models. We assessed the risk of bias using Quality Assessment of Diagnostic Accuracy Studies-2 tool. We included seven studies with 6037 participants. An Agile-4 score ≥0.565 yielded a pooled specificity of 0.93 (95% CI, 0.86-0.97). Similarly, an Agile-4 score <0.251 excluded cirrhosis with a summary sensitivity of 0.90 (0.80-0.95). Assuming a cirrhosis prevalence of 30%, the positive predictive value (PPV) for ruling-in cirrhosis was 80%, while the negative predictive value for ruling-out cirrhosis was 95%. Most studies were at high or unclear risk for bias due to concerns regarding patient selection and the blinding status of Agile-4 score interpretation in relation to biopsy results. Agile-4 score performs well for ruling-in/out liver cirrhosis in MASLD patients. Owing to the relatively low PPV, sequential application of the Agile-4 after fibrosis-4 index (FIB-4) testing might further enhance its performance.

Diagnostic accuracy of late iodine enhancement on cardiac CT for myocardial tissue characterization: a systematic review and meta-analysis.

to evaluate the diagnostic accuracy of late iodine enhancement (LIE) in cardiac computed tomography (CCT) compared to late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) for myocardial tissue characterization. EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting the accuracy of LIE with LGE as the gold standard of reference. QUADAS-2 tool was used to assess the risk of bias. A bivariate random-effects model was used to analyze, pool, and plot the diagnostic performance measurements across studies. Pooled sensitivity, specificity, positive (+LR) and negative (-LR) likelihood ratio, diagnostic odds ratio (DOR), and hierarchical summary ROC curve (HSROC) were computed. Prospero registration number: CRD42023484045. Fourteen studies involving 526 patients and 5758 myocardial segments were included. At the patient level, LIE in CCT showed a pooled sensitivity of 0.96 (95% CI: 0.88-0.99), specificity of 0.95 (95% CI: 0.88-0.98) and the HSROC AUC of 0.98 (95% CI: 0.97-0.99). The +LR was 20.97 (95% CI: 7.54-58.38) and the -LR was 0.04 (95% CI: 0.01-0.13), resulting in a DOR of 535 (95% CI: 94-3024). At the segment level, sensitivity was 0.86 (95% CI: 0.79-0.91), specificity was 0.98 (95% CI: 0.96-0.99), and the HSROC AUC was 0.97 (95% CI:0.95-0.98). The +LR was 55.08 (95% CI: 19.94-152.16) and the -LR was 0.14 (95% CI: 0.09-0.22) with a DOR of 388 (95% CI: 113-1333). Dual-energy CCT improved segment-level sensitivity to 0.93 (95% CI: 0.88-0.96). LIE in CCT shows excellent diagnostic accuracy when compared to LGE in CMR for myocardial tissue characterization, suggesting its potential as a promising alternative to CMR. Question How does myocardial tissue characterization by late iodine enhancement (LIE) on cardiac CT (CCT) compare to late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR)? Findings LIE in CCT demonstrates excellent diagnostic accuracy, with high sensitivity and specificity at both patient and segment levels, using LGE in CMR as the reference. Clinical relevance LIE in CCT provides a reliable alternative to LGE in CMR, especially for patients for whom CMR is not available or feasible or is contraindicated, thus improving access to myocardial tissue characterization.

What Is the Accuracy of 16S PCR Followed by Sanger Sequencing or Next-generation Sequencing in Native Vertebral Osteomyelitis? A Systematic Review and Meta-analysis.

Identifying a microorganism in patients with native vertebral osteomyelitis presents diagnostic challenges. Microorganism identification through culture-based methods is constrained by prolonged processing times and sensitivity limitations. Despite the availability of molecular diagnostic techniques for identifying microorganisms in native vertebral osteomyelitis, there is considerable variability in reported sensitivity and specificity across studies, leading to uncertainty in their clinical utility. What are the sensitivity, specificity, and diagnostic odds ratios for 16S broad-range PCR followed by Sanger sequencing (16S) and metagenomic next-generation sequencing (NGS) for detecting bacteria in native vertebral osteomyelitis? On June 29, 2023, we searched Cochrane, Embase, Medline, and Scopus for results from January 1970 to June 2023. Included studies involved adult patients with suspected native vertebral osteomyelitis undergoing molecular diagnostics-16S bacterial broad-range PCR followed by Sanger sequencing and shotgun or targeted metagenomic NGS-for bacteria detection. Studies involving nonnative vertebral osteomyelitis and cases of brucellar, tubercular, or fungal etiology were excluded. The reference standard for the diagnosis of native vertebral osteomyelitis was a composite clinical- and investigator-defined native vertebral osteomyelitis diagnosis. Diagnostic performance was assessed using a bivariate random-effects model. Risk of bias and diagnostic applicability were evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. After a manual screening of 3403 studies, 10 studies (5 on 16S, 5 on NGS) were included in the present analysis, from which 391 patients were included from a total of 958 patients overall. Quality assessment via QUADAS-2 criteria showed moderate risk of bias and good applicability. 16S showed 78% (95% confidence interval [CI] 95% CI 31% to 96%) sensitivity and 94% (95% CI 73% to 99%) specificity, whereas NGS demonstrated 82% (95% CI 63% to 93%) sensitivity and 71% (95% CI 37% to 91%) specificity. In addition, the diagnostic ORs were 59 (95% CI 9 to 388) and 11 (95% CI 4 to 35) for 16S and NGS, respectively. Summary receiver operating characteristic curves showed high test performance for 16S (area under the curve for 16S 95% [95% CI 93% to 97%] and for NGS 89% [95% CI 86% to 92%]). Certainty in estimates was moderate because of sample size limitations. This meta-analysis found moderate-to-high diagnostic performance of molecular methods on direct patient specimens for the diagnosis of native vertebral osteomyelitis. When used as a complementary test to microbiological analyses, a positive 16S result rules in the diagnosis of native vertebral osteomyelitis, while further studies are needed to understand the role of NGS in the diagnosis of native vertebral osteomyelitis. When available, these tests should be used in addition to conventional microbiology, especially in complex cases with extensively negative standard microbiological test results, to detect fastidious bacteria or to confirm the causative bacteria when their isolation and pathogenicity are unclear. A large sample size is needed in future research to understand the use of these techniques as standalone tests for diagnosis. Level III, diagnostic study.

Diagnostic performance of simultaneous multislice diffusion-weighted imaging in differentiating breast lesions: a systematic review and meta-analysis.

To investigate the diagnostic performance of simultaneous multislice diffusion-weighted imaging (SMS-DWI) in differentiating malignant and benign breast lesions, and compare it with conventional single shot and readout segmented echo planar imaging without the SMS technique. The literature search was performed in PubMed, Embase, and Web of Science to identify comparative studies reporting the diagnostic performance of SMS-DWI and conventional DWI in patients with breast lesions. Histopathological analysis was used as a reference standard for malignant breast lesions. The methodological quality was evaluated using QUADAS-2 scale. The summary sensitivity, summary specificity, and area under the curve (AUC) of the summarized receiver operating characteristic curve were calculated and compared between SMS-DWI and conventional DWI using a bivariate random-effects model. Heterogeneity was explored with meta-regression and subgroup analyses. Six studies with 626 patients and 649 breast lesions (benign: 222, malignant: 427) were included. The summary sensitivity, summary specificity, and AUC for SMS-DWI were 0.89 (95% CI: 0.78-0.95), 0.94 (95% CI: 0.81-0.98), and 0.96 (95% CI: 0.94-0.98), respectively, and those for conventional DWI were 0.90 (0.95 CI: 0.84-0.94), 0.87 (95% CI: 0.80-0.92), and 0.94 (95% CI: 0.92-0.96), respectively. The diagnostic performance was not significantly different between SMS-DWI and conventional DWI (P = .337). SMS-DWI has high diagnostic performance in differentiating breast lesions, which is not significantly different from the conventional DWI. There is no significant difference between SMS-DWI and conventional DWI in differentiating breast lesions, suggesting SMS-DWI may be a potential alternative to conventional DWI in breast imaging.

Accuracy of Fecal Polymerase Chain Reaction Testing in Clarithromycin-Resistant Helicobacter Pylori: A Systematic Review and Meta-Analysis.

The increasing prevalence of clarithromycin (CLA)-resistant Helicobacter pylori (H. pylori) strains poses a significant challenge in the management of H. pylori infections. This systematic review and meta-analysis investigates the diagnostic accuracy of Polymerase Chain Reaction (PCR) in identifying CLA-resistant H. pylori strains in stool. A comprehensive literature search was conducted using PubMed, EMBASE, and Cochrane databases from database inception to April 30, 2023. Eligible studies evaluated the effectiveness of PCR stool tests in detecting CLA-resistant H. pylori strains in adults (>18 years old). Studies of pediatric populations, alternative methods to PCR or stool samples, and reference tests other than gastric biopsy were excluded. The bivariate random-effects model was employed to pool diagnostic accuracy from the included studies. The analysis of eleven prospective diagnostic studies with a total of 866 patients showed a pooled sensitivity of 0.97 (95% CI: 0.9-0.99) and a pooled specificity of 0.98 (95% CI: 0.81-1.00). Subgroup analysis based on the employed technique demonstrated consistent findings without notable variations. The Diagnostic Odds Ratio (DOR) was calculated at 1843.92 (95% CI: 134.28 - 25321.3). The Positive Likelihood Ratio (+LR) was determined as 51.02 (95% CI: 4.61 - 564.5), while the Negative Likelihood Ratio (-LR) was found to be 0.03 (95% CI: 0.01- 0.1). PCR testing for clarithromycin-resistant H. pylori was highly sensitive and specific across studies with proven reliability in clinical practice, particularly in outpatient settings. Their implementation offers cost-effectiveness and the potential for tailored treatment strategies, holding promise for improved patient outcomes.

Efficacy of 18FDG-PET/CT in Detecting Synchronous Malignancies in Patients With Head and Neck Cancer: A Systematic Review and Meta-analysis.

To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (18FDG-PET/CT) in detecting second primary malignancies (SPMs) in patients with treatment naïve head and neck squamous cell carcinoma (HNSCC). Medline, Embase, Cochrane Library, and Scopus searched from 1946 to December 2022. Studies reporting the performance of 18FDG-PET/CT in patients with treatment-naïve, index HNSCC for detection of SPMs were included. The reference standard was histopathology, clinical follow-up over the duration of study, and other imaging modalities. Multiple investigators completed depth full-text analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Methodologic and diagnostic accuracy data were abstracted independently by multiple investigators. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies tool independently. Bivariate random-effects model meta-analysis and multivariable meta-regression modeling were used. Seventeen studies examining 4624 patients with a total of 475 SPMs were included in the final analysis. Eleven studies were found to be at low risk for bias, while the rest were in the high-risk category. 18FDG-PET/CT demonstrated pooled sensitivity and specificity of 0.73 (95% confidence interval [CI]: 0.49-0.88) and 0.99 (95% CI: 0.98-1.00) in detecting SPMs. Further subsite analysis revealed varied diagnostic performance across different anatomical regions, with sensitivity and specificity of esophageal SPMs being 0.47 (0.30-0.64) and 0.99 (0.98-1.00), and sensitivity and specificity of 0.86 (0.73-0.94) and 0.99 (0.98-1.00) for head and neck SPMs. Finally, this imaging modality showed sensitivity and specificity of 0.92 (0.84-0.96) and 0.99 (0.98-1.00) for lung SPMs. The findings of this study suggest varied accuracy of 18FDG-PET/CT in detecting SPMs during initial workup for HNSCC, highlighting the importance of screening modalities such as esophagoscopy in high-risk patients.

Performance of molecular tests for diagnosis of bloodstream infections in the clinical setting: a systematic literature review and meta-analysis.

Rapid identification of bloodstream pathogens and associated antimicrobial resistance (AMR) profiles by molecular tests from positive blood cultures (PBCs) have the potential to improve patient management and clinical outcomes. A systematic review and meta-analysis was conducted to evaluate diagnostic test accuracy (DTA) of molecular tests from PBCs for detecting pathogens and AMR in the clinical setting. MEDLINE, EMBASE, Cochrane, conference proceedings, and study bibliographies. Studies evaluating DTA of commercially available molecular tests versus traditional phenotypic identification and susceptibility testing methods (SOC) in patients with PBCs. Study quality assessed using QUADAS-2. Summary DTA outcomes were estimated using bivariate random-effects models for gram-negative bacteria (GNB), gram-positive bacteria (GPB), yeast, GNB-AMR, GPB-AMR, and specific targets when reported by ≥2 studies (PROSPERO CRD42023488057). Seventy-four studies including 24,590 samples were analysed, most of which had low risk of bias. When compared to SOC, molecular tests showed 92-99% sensitivity, 99-100% specificity, 99-100% positive predictive value (PPV), and 97-100% negative predictive value (NPV) for identifying total GNB (43 studies), GPB (38 studies), yeast (24 studies), GNB-AMR (35 studies), and GPB-AMR (39 studies). For individual pathogen targets, 93-100% sensitivity, 98-100% specificity, 86-100% PPV, and 99-100% NPV were estimated. Five of 7 AMR genes had 91-99% sensitivity and 99-100% specificity. Sensitivity was lower for IMP (4 studies; 62%, 95%CI 34%-83%) and VIM (4 studies; 70%, 95%CI 38%-90%) carbapenemases, where genes were not detected or were not harboured in P. aeruginosa (i.e., low prevalence). Performance of molecular tests in detecting AMR was generally comparable when grouped by geographic region (Europe, North America, and East Asia). High DTA support the use of molecular tests in identifying a broad panel of pathogens and detecting AMR in GNB and GPB.

White-Light Imaging and Image-Enhanced Endoscopy With Magnifying Endoscopy for the Optical Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis.

Optical diagnosis of superficial nonampullary duodenal epithelial tumors using white-light imaging (WLI) and/or narrow-band imaging with magnifying endoscopy (NBI-ME) is used to guide the treatment strategy and avoid biopsy-induced fibrosis. However, the effectiveness of this approach has not been elucidated. We conducted a systematic review and meta-analysis aiming to investigate the diagnostic yield between Vienna classification category 3 (VCL C3) and categories 4 or 5 (VCL C4/C5) using biopsy, WLI, NBI-ME, and WLI + NBI-ME. A literature search identified studies on the diagnosis of superficial nonampullary duodenal epithelial tumors using biopsy, WLI, or NBI-ME. A bivariate random-effects model was utilized to analyze the summary estimates of sensitivity and specificity, as well as the area under the summary receiver operating characteristic curves for diagnosing VCL C4/C5. Ultimately, 13 studies were included in the meta-analysis. For the diagnosis of VCL C4/C5, summary estimates of sensitivity, specificity, and area under the curve were for biopsy 47% (95% confidence interval: 37-58), 86% (79-91), and 0.745; for WLI 80% (65-89), 80% (70-87), and 0.859; for NBI-ME were 72% (61-81), 76% (68-85), and 0.811; and for WLI + NBI-ME 88% (67-96), 87% (51-98), and 0.929, respectively. WLI, NBI-ME, and WLI + NBI-ME showed high values for sensitivity and area under the curve. Biopsies can be replaced by WLI, NBI-ME, and WLI + NBI-ME for the preoperative diagnosis of superficial nonampullary duodenal epithelial tumors. However, further accumulation of research findings is needed.

Diagnostic performance of dual-energy computed tomography in detecting anterior cruciate ligament injuries: a systematic review and meta-analysis.

Anterior cruciate ligament (ACL) injuries are common and lead to significant physical limitations. While MRI is the diagnostic gold standard, its use is restricted in acute trauma cases due to contraindications and longer imaging times. Dual-energy computed tomography (DECT) has emerged as a potential alternative. This meta-analysis evaluates the diagnostic accuracy of DECT for ACL injuries. Following PRISMA guidelines, a comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and Embase for studies published up to June 2024. Studies that provided diagnostic accuracy data for DECT in ACL ruptures were included. Metrics of diagnostic accuracy were aggregated using a bivariate random effects model. The meta-analysis, which included five studies with a total of 191 patients, found that DECT had a pooled sensitivity of 88.1% (95% CI, 78.0-93.9%) and a specificity of 82.0% (95% CI, 62.0-92.7%) for diagnosing ACL ruptures, with an AUC of 0.92 (95% CI, 0.72-0.96). For complete ruptures, sensitivity was 83.2% (95% CI, 68.2-92.0%), and specificity was 94.9% (95% CI, 92.2-96.7%), with an AUC of 0.96 (95% CI, 0.81-0.98). In acute/subacute settings, sensitivity was 89.4% (95% CI, 76.8-95.6%), and specificity was 82.1% (95% CI, 56.2-94.2%), with an AUC of 0.93 (95% CI, 0.71-0.97). Our findings suggest that DECT is a valuable diagnostic tool for ACL injuries, particularly as an adjunct or alternative when MRI is unavailable or contraindicated, enabling timely and accurate diagnosis.

Diagnostic Accuracy of Optic Nerve Sheath Diameter Measurement by Ultrasonography for Noninvasive Estimation of Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Intracranial hypertension (IH) is associated with an unfavorable outcome in traumatic brain injury (TBI), and management strategies guided by intracranial pressure monitoring improve prognosis. Owing to the limitations of using invasive devices, measurement of optic nerve sheath diameter (ONSD) by ultrasonography is an alternative noninvasive method. However, its accuracy has not been validated in patients with TBI, so we aim to determine the diagnostic accuracy of measuring ONSD by ultrasonography in patients with TBI to estimate IH, compared with invasive monitoring. Systematic review of electronic databases and manual literature review from inception to June 2023. The analysis included diagnostic accuracy studies of ultrasonographic measurement of ONSD compared with invasive monitoring published in any language and with patients of any age. A qualitative synthesis was performed describing the clinical and methodological characteristics, strengths, limitations, and quality of evidence. In addition, a bivariate random effects model meta-analysis and a hierarchical summary receiver operating characteristics model were performed for the pediatric and adult population separately. Five hundred and forty eight patients of 688 in 16 eligible studies were adults and 120 were children. Pooled sensitivity and specificity of ONSD measurement by ultrasonography were 84% (95% CI, 76%-89%) and 83% (95% CI, 73%-90%), respectively. During the sensitivity analysis, these parameters exhibited consistent values. Pooled area under the curve was 0.91 for adults and 0.76 for children. Optimal threshold for estimating IH was 5.76 mm for adults and 5.78 mm for children. Measurement of ONSD by ultrasonography is a reliable, low-cost, and safe alternative for the estimation of IH with TBI in adults. More robust studies are needed to overcome the high risk of bias and heterogeneity for this analysis.

Node-RADS: a systematic review and meta-analysis of diagnostic performance, category-wise malignancy rates, and inter-observer reliability.

To perform a systematic review and meta-analysis to estimate diagnostic performance, category-wise malignancy rates, and inter-observer reliability of Node Reporting and Data System 1.0 (Node-RADS). Five electronic databases were systematically searched for primary studies on the use of Node-RADS to report the possibility of cancer involvement of lymph nodes on CT and MRI from January 1, 2021, until April 15, 2024. The study quality was assessed by modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Quality Appraisal of Diagnostic Reliability (QAREL) tools. The diagnostic accuracy was estimated with bivariate random-effects model, while the pooled category-wise malignancy rates were obtained with random-effects model. Six Node-RADS-CT studies and three Node-RADS-MRI studies covering nine types of cancer were included. The study quality was mainly damaged by inappropriate index test and unknown timing according to QUADAS-2, and unclear blindness during the rating process according to QAREL. The area under hierarchical summary receiver operating characteristic curve (95% conventional interval) was 0.92 (0.89-0.94) for Node-RADS ≥ 3 as positive and 0.91 (0.88-0.93) for Node-RADS ≥ 4 as positive, respectively. The pooled malignancy rates (95% CIs) of Node-RADS 1 to 5 were 4% (0-10%), 31% (9-58%), 55% (34-75%), 89% (73-99%), and 100% (97-100%), respectively. The inter-observer reliability of five studies was interpreted as fair to substantial. Node-RADS presented a promising diagnostic performance with an increasing probability of malignancy along higher category. However, the evidence for inter-observer reliability of Node-RADS is insufficient, and may hinder its implementation in clinical practice for lymph node assessment. Question Node-RADS is designed for structured reporting of the possibility of cancer involvement of lymph nodes, but the evidence supporting its application has not been summarized. Findings Node-RADS presented diagnostic performance with AUC of 0.92, and malignancy rates for categories 1-5 ranged from 4% to 100%, while the inter-observer reliability was unclear. Clinical relevance Node-RADS is a useful tool for structured reporting of the possibility of cancer involvement of lymph nodes with high diagnostic performance and appropriate malignancy rate for each category, but unclear inter-observer reliability may hinder its implementation in clinical practice.

The diagnostic performance of dual-energy CT imaging in cervical lymph node metastasis of papillary thyroid cancer: a meta-analysis.

This meta-analysis aimed to evaluate the diagnostic efficacy of dual-energy computed tomography (DECT) in detecting cervical lymph node metastasis among papillary thyroid cancer (PTC) patients. A comprehensive search across PubMed, Embase, and Web of Science databases was conducted to identify pertinent publications up to May 2024. This search focused on studies examining the diagnostic accuracy of DECT in detecting cervical lymph node metastases in PTC patients. We employed a bivariate random-effects model to calculate pooled sensitivity and specificity of DECT. The degree of heterogeneity in the studies was quantified using the I 2 statistic. Furthermore, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to evaluate the methodological quality of the included studies. This meta-analysis encompassed 14 articles, collectively involving 1,615 patients. The pooled sensitivity, specificity, and AUC for DECT in detecting cervical lymph node metastases in PTC patients were 0.81 (95% CI: 0.76-0.85), 0.86 (95% CI: 0.80-0.91), and 0.89 (95% CI: 0.86-0.92), respectively. According to Fagan's nomogram, for DECT, with a pre-test probability of 50%, the post-test probability was calculated as 85% for a positive result and 18% for a negative result. Deeks' funnel plot asymmetry test showed no significant publication bias was observed for DECT (p = 0.28). Our meta-analysis indicates that DECT demonstrates superior sensitivity and specificity in cervical lymph node metastasis among PTC patients. To corroborate these findings and evaluate their clinical applicability, further prospective studies are necessary.

Diagnostic accuracy of imaging modalities for detection of spinal metastases: a systematic review and meta-analysis.

Detecting spinal metastases is highly relevant in patients with oncological disorders as it can affect the staging and treatment of their disease. We aimed to evaluate the diagnostic performance of computed tomography (CT), magnetic resonance imaging (MRI), FDG positron emission tomography (PET)/CT, bone scintigraphy (BS), and single-photon emission computed tomography (SPECT) for spinal metastases detection. Medline, EMBASE, and Web of Science were systematically searched until March 2024 for diagnostic accuracy studies on spinal metastases detection (PROSPERO-registration: CRD42024540139). Data extraction and quality assessment using the QUADAS-2 tool were performed by two independent reviewers. Using bivariate random effects modeling, pooled sensitivities, specificities, and diagnostic odds ratios (DOR) were calculated, and hierarchical summary operating curves were constructed. Twenty-five studies (49 datasets), encompassing 3102 patients were included. Per-patient pooled sensitivities of CT, MRI, PET/CT, BS and SPECT were 70%, 93%, 82%, 75%, and 84%, respectively. Pooled specificities were 74%, 85%, 75%, 92%, and 81%, respectively. Per-lesion pooled sensitivities of CT, MRI, PET/CT, BS and SPECT were 76%, 91%, 92%, 77%, and 92%, respectively. Pooled specificities were 91%, 94%, 85%, 52%, and 86%, respectively. MRI had the highest DOR in per patient and lesion analyses. MRI had highest diagnostic accuracy for spinal metastases detection on patient and lesion level, suggesting a broader use in addition to the routine staging CT, at least in patients at high risk and where the detection of a spinal metastasis could alter therapy decisions. Herein, results should be considered with the limitations of each modality.

Deep learning approach to predict autism spectrum disorder: a systematic review and meta-analysis

BackgroundThe use of the deep learning (DL) approach has been suggested or applied to identify childhood autism spectrum disorder (ASD). The capacity to predict ASD, however, differs across investigations. Our study’s objective was to conduct a meta-analysis to determine the DL for ASD in children’s classification accuracy.MethodsEligibility criteria were designed according to the purpose of the meta-analysis; PubMed, EMBASE, Cochrane Library, and Web of Science Database were searched for articles published up to April 16, 2023, on the accuracy of DL methods for ASD classification. Using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) to assess the quality of the included studies. Sensitivity, specificity, areas under the curve (AUC), summary receiver operating characteristic (SROC), and corresponding 95% confidence intervals (CIs) were compiled by using the bivariate random-effects models.ResultsA total of 11 predictive trials based on DL models were included, involving 9495 ASD patients from 6 different databases. According to bivariate random-effects models’ results, the overall sensitivity, specificity, and AUC of the DL technique for ASD were, 0.95 (95% CI = 0.88–0.98), 0.93 (95% CI = 0.85–0.97), and 0.98 (95%CI: 0.97–0.99), respectively. Subgroup analysis results found that different datasets did not cause heterogeneity (meta-regression P = 0.55). The Kaggle dataset’s sensitivity and specificity were 0.94 (95%CI: 0.82-1.00) and 0.91 (95%CI: 0.76-1.00), and with 0.97 (95%CI: 0.92-1.00) and 0.97 (95%CI: 0.92-1.00) for ABIDE dataset.ConclusionsDL techniques has satisfactory sensitivity, specificity, and AUC in ASD classification. However, the major heterogeneity of the included studies limited the effectiveness of this meta-analysis. Further trials need to be performed to demonstrate the clinical practicability of DL diagnosis.