Diagnostic Meta-analysis Research Articles

Brief Assessment Tools for Obsessive Compulsive Disorders in Children: A Systematic Review.

Children and adolescents with suspected obsessive-compulsive disorder (OCD). To estimate the comparative performance of brief diagnostic assessment tools. PubMed, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, Embase, CINAHL, PsycINFO, and ERIC, and for unpublished studies with reported results in ClinicalTrials.gov through May 15, 2024. Studies of children (up to age 21) with a clinical suspicion of OCD that evaluated the accuracy (predictive validity) of brief assessment tools for OCD, compared to a reference standard. We extracted participant characteristics, scale and reference standard information, results, and risk of bias assessment. We performed random-effects diagnostic meta-analysis where feasible. We assessed strength of evidence for each scale. There is moderate strength of evidence that the 8-question version of the Child Behavior Checklist-Obsessive Compulsive subscale is sufficiently sensitive and specific (summary area under the curve of 0.84, 95% CI 0.74 to 0.91) to prompt specialist referral for additional diagnostic assessment. Other tools may perform as well or better, but the current evidence is insufficient to justify broad conclusions about their performance. Few studies per scale, case-control studies, and homogenous White populations may preclude generalizability of tool performance. Based on the current evidence the CBCL-OCS probably is sufficiently accurate to indicate which youth should be further evaluated for OCD, but further research is needed to establish that the 8-question subscale can function as a stand-alone measure. The available evidence is insufficient for other brief assessment tools.

DUPAN-2 in pancreatic cancer: Systematic review and meta-analysis.

Pancreatic cancer (PC) is a highly aggressive malignancy with poor prognosis and high mortality rate. Identifying reliable biomarkers for the early diagnosis and treatment is urgently needed. This study aims to comprehensively evaluate the diagnostic and prognostic value of DUPAN-2 in PC through a meta-analysis. We systematically searched PubMed, Embase, and other databases for studies related to DUPAN-2 and its prognostic and diagnostic relevance in PC, covering publications up to August 2024. We used pooled hazard ratios (HRs) to evaluate the prognostic value of DUPAN-2 in PC, the summary receiver operating characteristic (SROC) curve and the area under the curve (AUC) to assess diagnostic performance, while pooled odds ratios (ORs) analyzed associations with clinicopathological features. A total of 22 studies involving 4765 patients were included in this meta-analysis, with 11 studies focusing on diagnostic analysis, 10 on prognostic analysis, and 3 on clinicopathological features. The diagnostic meta-analysis revealed a pooled sensitivity of 0.63 (95 % CI: 0.56-0.69), a pooled specificity of 0.98 (95 % CI: 0.95-0.99), and an AUC of 0.83 (95 % CI: 0.79-0.86). Subgroup analysis indicated that a DUPAN-2 threshold at 150 U/mL achieved the highest diagnostic performance. The prognostic meta-analysis demonstrated that elevated DUPAN-2 levels were associated with poorer OS (HR = 1.70, 95 % CI: 1.36-2.14) and PFS (HR = 1.33, 95 % CI: 1.14-1.56). Additionally, the clinicopathological features meta-analysis showed that elevated DUPAN-2 levels were associated with vascular invasion (OR = 3.48, 95 % CI: 1.26-9.59), while normalized DUPAN-2 levels were associated with higher resectability (OR = 0.57, 95 % CI: 0.36-0.90) and lower N-stage (OR = 0.39, 95 % CI: 0.24-0.63) CONCLUSION: Serum DUPAN-2 demonstrates significant potential as a biomarker for diagnosis and prognosis in patients with PC.

Peak left atrial longitudinal strain and incident atrial fibrillation in the general population: a systematic review and meta-analysis

Background Atrial fibrillation (AF) is the commonest supraventricular arrhythmia in adults. Timely AF diagnosis seems to ameliorate patients prognosis. Purpose To investigate the association between peak left atrial longitudinal strain (PALS) and new onset AF in the general population. Objectives We searched major electronic databases for articles assessing the relationship between PALS and incident AF. Results Eight studies (11,145 patients) were analysed. Lower levels of PALS were significantly associated with higher risk of incident AF (HR: 0.95; 95%CI: 0.92–0.97, I 2: 83%). According to the diagnostic accuracy meta-analysis, PALS <33.4% presents 64% (95%CI: 46–79%) sensitivity and 69% (95%CI: 63–75%) specificity. Conclusions In a relatively healthy population, lower levels of PALS were significantly associated with incident AF. The overall diagnostic accuracy was moderate. Lower levels of PALS seem to justify an opportunistic – rather than a systematic-screening approach. These findings could allow more efficient utilisation of healthcare resources.

The performance of machine learning for predicting the recurrent stroke: a systematic review and meta-analysis on 24,350 patients.

Stroke is a leading cause of death and disability worldwide. Approximately one-third of patients with stroke experienced a second stroke. This study investigates the predictive value of machine learning (ML) algorithms for recurrent stroke. This study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Scopus, Embase, and Web of Science (WOS) were searched until January 1, 2024. The quality assessment of studies was conducted using the QUADAS-2 tool. The diagnostic meta-analysis was conducted to calculate the pooled sensitivity, specificity, diagnostic accuracy, positive and negative diagnostic likelihood ratio (DLR), diagnostic accuracy, diagnostic odds ratio (DOR), and area under of the curve (AUC) by the MIDAS package in STATA V.17. Twelve studies, comprising 24,350 individuals, were included. The meta-analysis revealed a sensitivity of 71% (95% CI 0.64-0.78) and a specificity of 88% (95% confidence interval (CI) 0.76-0.95). Positive and negative DLR were 5.93 (95% CI 3.05-11.55) and 0.33 (95% CI 0.28-0.39), respectively. The diagnostic accuracy and DOR was 2.89 (95% CI 2.32-3.46) and 18.04 (95% CI 10.21-31.87), respectively. The summary ROC curve indicated an AUC of 0.82 (95% CI 0.78-0.85). ML demonstrates promise in predicting recurrent strokes, with moderate to high sensitivity and specificity. However, the high heterogeneity observed underscores the need for standardized approaches and further research to enhance the reliability and generalizability of these models. ML-based recurrent stroke prediction can potentially augment clinical decision-making and improve patient outcomes by identifying high-risk patients.

Minimum Fascia-Tumour Distance for Differentiating Deep Lobe From Superficial Lobe Benign Parotid Tumours: A Retrospective Study and Meta-Analysis.

This study was designed to evaluate the diagnostic efficacy of the minimum fascia-tumour distance (MFTD) in distinguishing deep-lobe benign parotid tumours from superficial-lobe tumours through both an original study and a meta-analysis. In this study, we performed a retrospective analysis of data from 91 patients who had been diagnosed with benign parotid tumours. The MFTD values were sourced from preoperative ultrasound examinations. The locations of these tumours were confirmed through surgical findings. We assessed the diagnostic accuracy of MFTD by utilising receiver operating characteristic (ROC) curves. Additionally, we conducted a systematic review of the pertinent literature and performed a diagnostic meta-analysis to ascertain the overall diagnostic efficacy of MFTD in identifying benign parotid tumours. Patients with tumours in the deep lobe had a significantly greater MFTD than patients with tumours in the superficial lobe. Using a cutoff value of 3.50 mm for MFTD, we found an AUC of 0.93, a sensitivity of 81.8%, and a specificity of 98.8%. Our meta-analysis included seven studies covering a total of 1689 tumours. The pooled values for sensitivity, specificity, and diagnostic odds ratio (OR) of MFTD were 81.0%, 89.0%, and 32.2, respectively. The AUC of the summarised ROC curve of MFTD was 0.90. The MFTD demonstrated reliable diagnostic accuracy in identifying deep-lobe benign parotid tumours and may be incorporated into standard evaluations before parotidectomy.

The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).

Diagnostic accuracy of signs and symptoms in acute coronary syndrome and acute myocardial infarction

Background Acute coronary syndrome (ACS) and acute myocardial infarction (AMI) account for a large portion of cardiovascular deaths. Signs and symptoms for these syndromes, such as chest pain, are non-specific and can be caused by a variety of non-cardiac conditions, especially in low-prevalence settings such as general practice. The diagnostic value of these signs and symptoms can be assessed using diagnostic meta-analyses, but the last one dates from 2012. Methods We performed a diagnostic meta-analysis in accordance with PRISMA guidelines. We searched PubMed, Embase and CENTRAL from 2006 to 2024. We included studies that assessed the diagnostic accuracy of thirteen different signs and symptoms. We divided patients into two subgroups (AMI and ACS) on which analysis was performed independently. Results We selected 24 articles for inclusion. Our analysis indicates that signs and symptoms have a limited role in the diagnosis of AMI or ACS. The most useful (highest diagnostic odds ratios, DOR) in the diagnosis of AMI were pain radiating to both arms (DOR 2.95 (95%CI 1.57–5.06)), absence of chest wall tenderness (DOR 3.51 (95%CI 1.64–6.61)), pain radiating to the right arm (DOR 5.17 (95%CI 1.77–11.9)) and sweating (DOR 5.75 (95%CI 2.51–11.4)). For ACS these were pain radiating to the right arm (DOR 3.9 (95%CI 0.7–12.6)) and absence of chest wall tenderness (DOR 7.73 (95%CI 2.19–19.8)). Conclusion We report the accuracy of thirteen signs and symptoms in the diagnosis of AMI and ACS. These can be useful to calibrate general practitioners’ diagnostic assessment of chest pain in primary care settings.

Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments.

Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews of history, physical examination, laboratory testing, and ED screening instruments for the diagnosis of delirium as well as test-treatment thresholds for ED delirium screening. We conducted a systematic review to quantify the diagnostic accuracy of approaches to identify delirium. Studies were included if they described adults aged 60 or older evaluated in the ED setting with an index test for delirium compared with an acceptable criterion standard for delirium. Data were extracted and studies were reviewed for risk of bias. When appropriate, we conducted a meta-analysis and estimated delirium screening thresholds. Full-text review was performed on 55 studies and 27 were included in the current analysis. No studies were identified exploring the accuracy of findings on history or laboratory analysis. While two studies reported clinicians accurately rule in delirium, clinician gestalt is inadequate to rule out delirium. We report meta-analysis on three studies that quantified the accuracy of the 4 A's Test (4AT) to rule in (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7-20.7) and rule out (pooled negative likelihood ratio [LR-] 0.18, 95% CI 0.09-0.34) delirium. We also conducted meta-analysis of two studies that quantified the accuracy of the Abbreviated Mental Test-4 (AMT-4) and found that the pooled LR+ (4.3, 95% CI 2.4-7.8) was lower than that observed for the 4AT, but the pooled LR- (0.22, 95% CI 0.05-1) was similar. Based on one study the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is the superior instrument to rule in delirium. The calculated test threshold is 2% and the treatment threshold is 11%. The quantitative accuracy of history and physical examination to identify ED delirium is virtually unexplored. The 4AT has the largest quantity of ED-based research. Other screening instruments may more accurately rule in or rule out delirium. If the goal is to rule in delirium then the CAM-ICU or brief CAM or modified CAM for the ED are superior instruments, although the accuracy of these screening tools are based on single-center studies. To rule out delirium, the Delirium Triage Screen is superior based on one single-center study.

A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of Endometrial Sampling Tests for Detecting Endometrial Cancer

Abstract Objectives to determine the diagnostic accuracy of different endometrial sampling tests for detecting endometrial carcinoma. Design a systematic review and meta-analysis of studies of diagnostic accuracy. Eligibility Criteria We included published diagnostic test accuracy studies of women, of all ages, who had an endometrial sampling for preoperatively detecting endometrial cancer with verification using histopathology of hysterectomy specimens as the reference standard. We excluded case control and case series studies. Information Sources We searched the Cochrane library, MEDLINE/PubMed, CINAHL, Web of Science, and Scopus from the date of inception of the databases to January 18, 2023. We did not apply any restrictions on language or date of publication. We searched the references of included studies and other systematic reviews. Risk of Bias We extracted study data and assessed study quality using the revised quality assessment tool for diagnostic accuracy studies (QUADAS-2). Synthesis of Results We used bivariate diagnostic random-effects meta-analysis and presented the results in a summary receiver operating characteristic curve. We assessed the certainty of evidence as recommended by the GRADE approach. Results Twelve included studies, published between 1986 and 2022, recruited 1607 participants. Seven studies were low risk of bias in all domains and all studies had low applicability concerns. The most examined index tests were Pipelle and conventional dilation and curettage. For diagnosing endometrial carcinoma, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio (95% confidence intervals), for Pipelle were 0.774 (0.565, 0.900), 0.985 (0.927, 0.997), 97.000 (14.000, 349.000), and 0.241 (0.101, 0.442) and for conventional dilation and curettage were 0.773 (0.333, 0.959), 0.987 (0.967, 0.995), 62.300 (18.600, 148.000), and 0.268 (0.042, 0.676); respectively. Conclusion High certainty evidence indicates that pre-operative endometrial sampling particularly using Pipelle or conventional curettage is accurate in diagnosing endometrial cancer. Studies assessing other endometrial sampling tests were sparse. Systematic review Registration Center for Open Science, osf.io/h8e9z

S1871 To Biopsy or Not to Biopsy: A Cochrane Diagnostic Meta-Analysis of Non-Invasive Biomarkers for Acute T-Cell Mediated Liver Transplant Rejection

S1871 To Biopsy or Not to Biopsy: A Cochrane Diagnostic Meta-Analysis of Non-Invasive Biomarkers for Acute T-Cell Mediated Liver Transplant Rejection

Comparative Diagnostic Accuracy of Nursing Delirium Screening Scale Versus Confusion Assessment Method forPostoperative Delirium: A Systematic Review and Meta-Analysis.

To synthesise the evidence on and to compare the diagnostic accuracy of the Nu-DESC and CAM in detecting postoperative delirium among hospitalised patients. Systematic review and diagnostic meta-analysis. The PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses A&I, and PsycINFO databases were systematically searched from their inception to February 10, 2023. In total, 10 (n = 1950) and seven (n = 830) reports were included for the Nu-DESC and CAM, respectively. For Nu-DESC and CAM, the pooled sensitivities were 0.69 and 0.65, respectively, while the summary specificities were 0.99 for Nu-DESC and 0.92 for CAM. The pooled specificity differed significantly between the two tools (p < 0.001), despite comparable pooled sensitivities. The duration of stay in the intensive care unit significantly moderated the summary specificity of Nu-DESC (B = -0.0003, p = 0.009). Regarding CAM, the percentage of female participants showed a positive correlation with its pooled sensitivity (B = 0.005, p = 0.02). Furthermore, studies where clinical specialists served as assessors demonstrated a higher summary sensitivity than those assessed by nurses (0.87 vs. 0.25, p = 0.01). The sensitivities of the Nu-DESC and CAM for detecting postoperative delirium did not achieve optimal levels. Therefore, developing more accurate tools to detect postoperative delirium by integrating features from related risk factors or incorporating technology-based algorithms to enhance the screening capability is warranted. The study has adhered to PRISMA-DTA guideline. No patient or public contribution. The study protocol has been registered on PROSPERO (CRD42023398961).

The serological diagnostic value of EBV-related IgA antibody panels for nasopharyngeal carcinoma: a diagnostic test accuracy meta-analysis

BackgroundNasopharyngeal carcinoma (NPC) is diagnosed relatively late and has a poor prognosis, requiring early detection to reduce the disease burden. This diagnostic test accuracy meta-analysis evaluated the serological diagnostic value of nine EBV-related IgA antibody panels (EBNA1-IgA, VCA-IgA, EA-IgA, Zta-IgA, EBNA1-IgA + VCA-IgA, VCA-IgA + EA-IgA, VCA-IgA + Rta-IgG, EBNA1-IgA + VCA-IgA + Zta-IgA and VCA-IgA + EA-IgA + Rta-IgG), aiming to identify suitable serological detection biomarkers for NPC screening.MethodsPubMed, Embase, China National Knowledge Infrastructure and Chinese BioMedical Literature Database were searched from January 1st, 2000 to September 30th, 2023, with keywords nasopharyngeal carcinoma, IgA, screening, early detection, early diagnosis, sensitivity and specificity. Articles on the diagnostic value of serum EBV-related IgA antibody panels for NPC were included. Study selection, data extraction, and quality assessment were performed independently by two researchers, and a third researcher was consulted in the case of disagreement. Bivariate models were used for statistical analysis. The quality of included studies was evaluated through Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2).ResultsA total of 70 articles were included, involving 11 863 NPC cases and 34 995 controls. Among the nine EBV-related IgA antibody panels, EBNA1-IgA + VCA-IgA [0.928 (0.898, 0.950)], VCA-IgA + Rta-IgG [0.925 (0.890, 0.949)], EBNA1-IgA + VCA-IgA + Zta-IgA [0.962 (0.909, 0.985)] and VCA-IgA + EA-IgA + Rta-IgG [0.945 (0.918, 0.964)] demonstrated higher pooled sensitivity (95%CI). In terms of diagnostic odds ratio (DOR) (95%CI), EBNA1-IgA + VCA-IgA [107.647 (61.173, 189.430)], VCA-IgA + Rta-IgG [105.988 (60.118, 186.857)] and EBNA1-IgA + VCA-IgA + Zta-IgA [344.450 (136.351, 870.153)] showed superior performance. Additionally, the SROC curves for EBNA1-IgA + VCA-IgA and VCA-IgA + Rta-IgG were more favorable. However, publication bias was detected for VCA-IgA (P = 0.005) and EBNA1-IgA + VCA-IgA (P = 0.042).ConclusionsIn general, parallel detection of serum EBNA1-IgA, VCA-IgA and Zta-IgA antibodies using ELISA demonstrates better pooled sensitivity and DOR among the studied panels. In the cases where fewer indicators are used, serum VCA-IgA and EBNA1-IgA/Rta-IgG antibody panel exhibits a comparable performance.Trial registrationThe International Prospective Register of Systematic Reviews registration number: CRD42023426984, registered on May 28, 2023.

Slow left atrial conduction velocity in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation recurrence after catheter ablation-Systematic review and meta-analysis.

This study aimed to investigate and perform diagnostic test meta-analysis on whether slow left atrial conduction velocity (LACV) in the anterior wall calculated by electroanatomic mapping predicts atrial fibrillation (AF) recurrence after catheter ablation. Extensive literature search was performed on PubMed, SCOPUS, and EuropePMC up to June 5, 2024. The exposure group included AF patients with slow LACV in the anterior wall, while the control group included AF patients without slow LACV in the anterior wall. Slow LACV in the anterior wall was defined as LACV below study-specific cut-off points in m/s, measured by invasive electroanatomic mapping. The primary outcome of this study was AF recurrence, defined as AF/Atrial Flutter/Atrial Tachyarrhythmias lasting over 30 s at least 3 months after the blanking period postablation. This systematic review and meta-analysis included seven studies, involving a sample size of 1428 patients with mean follow-up duration were 13 months. Patients with AF recurrence has slower LACV in the anterior wall (mean difference - 0.16 m/s [-0.18, -0.15], p < .001). Slow LACV in the anterior wall defined as LACV below 0.70-0.88 m/s was associated with increased AF (adjusted OR 3.41 [1.55, 7.50], p = .002). Slow LACV in the anterior wall has an AUROC of 0.80 [0.76-0.83], sensitivity of 70% [52, 84], specificity of 76% [67, 83], positive likelihood ratio of 2.9 [2.3, 3.6], negative likelihood ratio of 0.39 [0.25, 0.63] for predicting AF recurrence postablation. Slow LACV in the anterior wall was associated with AF recurrence after catheter ablation.

Diagnostic Accuracy of AI Algorithms in Aortic Stenosis Screening: A Systematic Review and Meta-Analysis.

Background: Aortic stenosis (AS) is frequently identified at an advanced stage after clinical symptoms appear. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of artificial intelligence (AI) algorithms for AS screening.Methods: We conducted a thorough search of six databases. Several evaluation parameters, such as sensitivity, specificity, diagnostic odds ratio (DOR), negative likelihood ratio (NLR), positive likelihood ratio (PLR), and area under the curve (AUC) value were employed in the diagnostic meta-analysis of AI-based algorithms for AS screening. The AI algorithms utilized diverse data sources including electrocardiograms (ECG), chest radiographs, auscultation audio files, electronic stethoscope recordings, and cardio-mechanical signals from non-invasive wearable inertial sensors.Results: Of the 295 articles identified, 10 studies met the inclusion criteria. The pooled estimates for AI-based algorithms in diagnosing AS were as follows: sensitivity 0.83 (95% CI: 0.81-0.85), specificity 0.81 (95% CI: 0.79-0.84), PLR 4.78 (95% CI: 3.12-7.32), NLR 0.20 (95% CI: 0.13-0.28), and DOR 27.11 (95% CI: 14.40-51.05). The AUC value was 0.909 (95% CI: 0.889-0.929), indicating outstanding diagnostic accuracy. Subgroup and meta-regression analyses showed that continent, type of AS, data source, and type of AI-based method constituted sources of heterogeneity. Furthermore, we demonstrated proof of publication bias for DOR values analyzed using Egger's regression test (P = 0.002) and a funnel plot.Conclusion: Deep learning approaches represent highly sensitive, feasible, and scalable strategies to identify patients with moderate or severe AS.

Diagnostic and prognostic role of microRNA-525 in different cancers: a systematic review and meta-analysis.

New prospect of cancer therapeutical management seems to be early diagnosis and prognosis prediction by microRNAs. The aim of our study is to explore the role of miR-525 in cancer diagnosis and prognosis through a systematic review and meta-analysis. We conducted systematic search on PubMed, Embase, Web of Science, Scopus, Medline, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases as at November 25, 2023, regardless of languages. Sensitivity, specificity, and diagnostic odds ratio (DOR) were extracted for diagnostic meta-analysis, while hazard ratio (HR) with 95% confidence interval (CI) for prognostic meta-analysis. Subgroup analysis and publication bias analysis were performed appropriately to investigate possible sources of heterogeneity. A total of 8 studies were included in the meta-analysis, of which 7 were used for diagnostic meta-analysis, covering 559 patients, and 3 were used for prognostic meta-analysis, covering 324 patients. The pooled sensitivity was 0.75 (95% CI: 0.70-0.79), specificity was 0.73 (95% CI: 0.68-0.78), DOR was 13.08 (95% CI: 4.18-40.91), and the area under the curve (AUC) was 0.86 (95% CI: 0.83-0.89). Subgroup analysis showed that miR-525 may have good diagnostic ability in the early tumor node metastasis (TNM) stage of cancer. Prognostic meta-analysis showed that low miR-525 expression in patients was associated with preferable survival (HR =0.17, 95% CI: 0.07-0.41). Our findings suggest that miR-525 could be used as a potential biomarker for cancer patients. Low expression of miR-525 in cancers predicted a good prognosis.

Diagnostic performance of contrast enhancement to differentiate benign and malignant renal lesions in CT and MRI: a systematic review and meta-analysis of diagnostic test accuracy (DTA) studies.

To perform a systematic review and meta-analysis of the diagnostic performance of contrast enhancement to differentiate benign and malignant renal lesions using CT and MRI. A systematic literature search of databases was performed between January 1, 1980 and September 26, 2022. We included studies reporting the accuracy of CE thresholds on CT and MRI indeterminate renal lesions, with pathologic examination and follow-up as the reference standard. Studies meeting the inclusion criteria underwent quality assessment with the Cochrane recommendation for diagnostic accuracy study Quality Assessment 2. We excluded studies with high risk of bias. Summary estimates of diagnostic performance were obtained with the bivariate Bayesian model for CT and MRI. Effects of different thresholds and index test modalities were investigated through subgroup analysis. Eleven studies (1372 patients) using CT and six studies (218 patients) using MRI were included. Of the eleven studies, 15 parts from 9 studies were considered for the CT meta-analysis, and 6 parts from 3 studies for the MRI meta-analysis. Diagnostic performance meta-analysis on enhancement found a 96% summary sensitivity (95% CI 92, 98) and a 92% summary specificity (95% CI 85, 96) in 2056 renal lesions for CT; and 82% summary sensitivity (95% CI 65, 89) and an 89% summary specificity (95% CI 77, 95) in 634 lesions for MRI. CT and MRI have high accuracy to determine enhancement and classify renal lesions, and both modalities can be used with confidence for this purpose. There are still some controversies about the optimal thresholds. Future research should evaluate outcomes and decision-making pathways to determine whether basing clinical decisions on a specific threshold on CT and MRI would do more harm than good.

Predicting telomerase reverse transcriptase promoter mutation in glioma: A systematic review and diagnostic meta-analysis on machine learning algorithms.

Glioma is one of the most common primary brain tumors. The presence of the telomerase reverse transcriptase promoter (pTERT) mutation is associated with a better prognosis. This study aims to investigate the TERT mutation in patients with glioma using machine learning (ML) algorithms on radiographic imaging. This study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The electronic databases of PubMed, Embase, Scopus, and Web of Science were searched from inception to August 1, 2023. The statistical analysis was performed using the MIDAS package of STATA v.17. A total of 22 studies involving 5371 patients were included for data extraction, with data synthesis based on 11 reports. The analysis revealed a pooled sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.80 (95% CI 0.72-0.86). The positive and negative likelihood ratios were 4.23 (95% CI: 2.99-5.99) and 0.18 (95% CI: 0.11-0.29), respectively. The pooled diagnostic score was 3.18 (95% CI: 2.45-3.91), with a diagnostic odds ratio 24.08 (95% CI: 11.63-49.87). The Summary Receiver Operating Characteristic (SROC) curve had an area under the curve (AUC) of 0.89 (95% CI: 0.86-0.91). The study suggests that ML can predict TERT mutation status in glioma patients. ML models showed high sensitivity (0.86) and moderate specificity (0.80), aiding disease prognosis and treatment planning. However, further development and improvement of ML models are necessary for better performance metrics and increased reliability in clinical practice.

Comparison of the accuracy of hematological parameters in the diagnosis of neonatal sepsis: a network meta-analysis.

Currently, there are hundreds of hematological parameters used for rapid diagnosis of neonatal sepsis, but there is no network meta-analysis to compare the diagnostic efficacy of these parameters. We searched for literature on the diagnostic neonatal sepsis and selected 20 of the most common parameters to compare their diagnostic efficacy. We used Bayesian network meta-analysis, Frequentist network meta-analysis, and individual traditional diagnostic meta-analysis to analyze the data and verify the stability of the results. Based on the above analysis, we ranked the diagnostic efficacy of 20 parameters and searched for the optimal indicator. We also conducted subgroup analysis based on different designs. GRADE was used to evaluate the quality of evidence. 311 articles were included in the analysis, of which 206 articles were included in the network meta-analysis. Bayesian models fond the top three of the advantage index were P-SEP, SAA, and CD64. In Individual model, P-SEP, SAA, and CD64 had the best sensitivity; ABC, SAA, and P-SEP had the best specificity. Frequentist model showed that CD64, P-SEP, and IL-10 ranked in the top three for sensitivity, while P-SEP, ABC, and I/M in specificity. Overall, P-SEP, SAA, CD64, and PCT have good sensitivity and specificity among all the three methods. The results of subgroup analysis were consistent with the overall analysis. All evidence was mostly of moderate or low quality. P-SEP, SAA, CD64, and PCT have good diagnostic efficacy for neonatal sepsis. However, further studies are required to confirm these findings.

Meta-analysis of the accuracy of the serum procalcitonin diagnostic test for osteomyelitis in children

ObjectiveThis study sought to assess the sensitivity, specificity, and predictive utility of serum procalcitonin (PCT) in the diagnosis of pediatric osteomyelitis.MethodsA systematic computer-based search was conducted for eligible literature focusing on PCT for the diagnosis of osteomyelitis in children. Records were manually screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analysis was performed using Review Manager software 5.3, Meta-disc software1.4, STATA 12.0, and R 3.4 software.ResultA total of 5 investigations were included. Of these, 148 children with osteomyelitis were tested for bacterial cultures in PCT. For PCT in the diagnosis of pediatric osteomyelitis, diagnostic meta-analysis revealed a pooled sensitivity and specificity of 0.58 (95% confidence interval (CI): 0.49 to 0.68) and 0.92 (95% CI: 0.90 to 0.93) respectively. The PCT had the greatest area under the curve (AUC) at 0.80 for the diagnosis of osteomyelitis in children. The Deeks’ regression test for asymmetry results indicated that there was no publication bias when evaluating publication bias (P = 0.90).ConcusionThis study provided a comprehensive review of the literature on the use of PCT in pediatric osteomyelitis diagnosis. PCT may be used as a biomarker for osteomyelitis diagnosis; however, its sensitivity was low. It still needs to be validated by a large sample study.

An Overview on Prevalence and Detection Approaches of BRAF V600E Mutation in Anaplastic Thyroid Carcinoma: A Systematic Review and Meta-Analysis.

BRAF V600E mutation is proved critical in the progression and invasion of thyroid cancer, and as a prognostic biomarker. As anaplastic thyroid cancer (ATC) is a rare and aggressive form of thyroid cancer, this study was conducted to provide a view on prevalence of BRAF V600E as well as the best molecular diagnostic method in ATC patients. A comprehensive literature search was performed from their inception to Oct 2022 in PubMed, Scopus, Google Scholar, and Web of Science (WoS). The data of the prevalence of ATC were extracted. Moreover, the diagnostic feature of the available diagnostic tools was extracted to measure the sensitivity and specificity. To pool the prevalence data, we used meta-proportion analysis and diagnostic meta-analysis was conducted to determine the specificity and sensitivity of the immunohistochemistry method in detecting BRAF V600E mutation among patients with ATC. Overall, 34 studies were included in this meta-analysis. The incidence of BRAF V600E was shown 33% in the 978 patients. The sensitivity and specificity of IHC in detecting BRAF V600E were detected 78.9% (95%CI: 60.1-97.2), and 69.7% (95%CI: 41.2-98.1), respectively. IHC had an acceptable prognostic profile for detecting BRAF V600E in ATC patients. The diagnosis of BRAF mutation is critical in clinical trials and may be helpful for choosing proper-targeted therapy strategies in ATC patients.