Diagnostic Meta-analysis Research Articles

Diagnostic accuracy of blood tests of inflammation in paediatric appendicitis: a systematic review and meta-analysis

ObjectivePossible childhood appendicitis is a common emergency presentation. The exact value of blood tests is debated. This study sought to determine the diagnostic accuracy of four blood tests (white cell...

Potential Modifiers and Different Cut-offs in Diagnostic Accuracy of Fecal Immunochemical Test in Detecting Advanced Colon Neoplasia: A Diagnostic Test Accuracy Meta-analysis.

Background: Fecal immunoglobulin test (FIT) has been advocated as the first line of screening for colorectal cancer (CRC) in several jurisdictions. Most studies have focused on CRC as the outcome of interest. Our goal was to quantify the diagnostic accuracy of different thresholds of FIT as compared with colonoscopy for detection of advanced colonic neoplasia and potential modifiers using proper Cochrane methodology. Methods: A comprehensive electronic search was performed for studies on FIT using colonoscopy as the reference standard to detect advanced neoplasia. Cochrane methodology was used to perform a diagnostic test accuracy (DTA) meta-analysis. Diagnostic accuracy of different cut-offs of FIT, including 25, 50, 75, 100, 150, and 200 ng/mL, were calculated separately. Meta-regression analysis was also performed to detect potential a priori modifiers, including age, location of the tumor, and time from FIT to colonoscopy. Results: Twenty-four studies were included with no evidence of publication bias. The sensitivity of FIT did not decrease with lowering the cut-off, although specificity increased in higher cut-offs. Commonly used cut-offs of 50 ng/mL, 75 ng/mL, and 100 ng/mL for FIT provided sensitivity of 39%, 36%, 27% and specificity of 92%, 94%, 96%, respectively. Diagnostic accuracy of FIT did not significantly differ in proximal versus distal lesions or in individuals below or over the age of 50 years. The results remained robust in a meta-regression of the location of the study, time from FIT to colonoscopy, and methodological quality. Conclusion: The sensitivity of FIT might have been overestimated in previous studies focusing on CRC, and it seems to be independent of age, location of neoplasia, or cut-offs, contrary to some previous studies. Lowering the cut-off will reduce the diagnostic odds ratio (DOR) by increasing specificity but without any effect on sensitivity.

A Comparison of Modalities to Differentiate Radiation Necrosis from Tumor Progression: A Diagnostic Meta-Analysis

<h3>Purpose/Objective(s)</h3> Cerebral radiation necrosis is a complication following radiation treatment to the brain. It is hypothesized that radiation treatment causes vascular injury, leading to tissue ischemia and then radiation necrosis. Radiation necrosis is a delayed phenomenon, occurring several months to years after the completion of radiation therapy. Radiation necrosis can be difficult to diagnose as it appears similar to tumor progression on standard magnetic resonance imaging (MRI). The ability to distinguish the two is important for further treatment strategies, and there is no current guideline on which imaging modality should be used. Various imaging modalities have been studied as an alternative to MRI, including, but not limited to, MR perfusion techniques (MRP), MR spectroscopy (MRS), single photon emission computed tomography (SPECT), and positron emission tomography (PET). We aim to review the existing literature and perform a diagnostic meta-analysis comparing these different imaging modalities to differentiate radiation necrosis from tumor progression. <h3>Materials/Methods</h3> A systematic review adherent to PRISMA guidelines was performed using Scopus and PubMed databases. Sensitivities and specificities were pooled using the inverse-variance method, and 95% confidence intervals were calculated. To compare modalities, Euclidean distances are calculated as the absolute distance from the point (1.0, 1.0) of a theoretical ideal classifier on a graph of sensitivity vs. specificity. For evaluation of Euclidean distance, the lower the value, the closer the test is to optimal, which would be a sensitivity and specificity of 1. <h3>Results</h3> The analysis includes 113 studies with a total of 200 imaging data points, including the following imaging modalities: MRI (n = 13), MRS (n = 21), MRP (n = 12), Dynamic Contrast Enhanced (DCE) MRI (n = 4), Dynamic Susceptibility Contrast MRI (n = 20), MR arterial spin labeling (ASL) (n = 3), Diffusion Weighted Imaging (n = 11), Diffusion Tensor Imaging (DTI) (n = 2), PET (n = 88), and SPECT (n = 26). MRS had the highest pooled sensitivity at 0.92 (95% CI: 0.84 - 0.96), followed by DCE MRI (0.88; 95% CI: 0.70 - 0.96) and then SPECT (0.88; 95% CI: 0.82 - 0.93). The highest pooled specificities were DTI at 0.90 (95% CI: 0.69 - 0.98), SPECT at 0.88 (95% CI: 0.83 - 0.92), and DCE MRI at 0.85 (95% CI: 0.71 - 0.93). For Euclidean distances, SPECT had the lowest at 0.163 (95% CI: 0.106 - 0.248), followed by MRS (0.167; 95% CI: 0.100 - 0.275), and DCE MRI (0.185; 95% CI: 0.077 - 0.414). MRI had the highest Euclidean distance at 0.373 (95% CI: 0.238 - 0.542). <h3>Conclusion</h3> The results from this diagnostic meta-analysis evaluating pooled sensitivities, pooled specificities, and Euclidean distances indicate that SPECT and MRS appear to be promising imaging modalities for the differentiation of radiation necrosis from tumor progression. This study may have implications in the formation of imaging guidelines for this purpose.

Can serum autoantibodies be a potential early detection biomarker for breast cancer in women? A diagnostic test accuracy review and meta-analysis

BackgroundThe increasing incidence of breast cancer necessitates the need to explore alternate screening strategies that circumvent the setbacks of conventional techniques especially among population that report earlier age at diagnosis. Serum autoantibodies is one such potential area of interest. However, their ubiquitous presence across cancer types limits its applicability to any one specific type of cancer. This review was therefore carried out to explore and consolidate available evidence on autoantibodies for early detection of breast cancer and to identify those that demonstrated a higher sensitivity.MethodsA diagnostic test accuracy (DTA) review was carried out to ascertain serum autoantibodies that could be used for early detection of breast cancer among women. All relevant articles that investigated the role of autoantibodies in early detection of breast cancer were included for the review. MEDLINE, Scopus, ProQuest, Ovid SP, and Cochrane Library were searched extensively for eligible studies. Quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. RevMan 5.3 was used for exploratory and MetaDTA 2019 for hierarchical analyses. The review helped identify the most frequently investigated autoantibodies and a meta-analysis further consolidated the findings.ResultsA total of 53 articles were included for the final analysis that reported over a 100 autoantibodies that were studied for early detection of breast cancer in women. P53, MUC1, HER2, HSP60, P16, Cyclin B1, and c-Myc were the most frequently investigated autoantibodies. Of these P53, MUC1, HER2, and HSP60 exhibited higher summary sensitivity measures. While the individual pooled sensitivity estimates ranged between 10 and 56%, the panel sensitivity values reported across studies were higher with an estimated range of 60–87%.ConclusionFindings from the review indicate a higher sensitivity for an autoantibody panel in comparison to individual assays. A panel comprising of P53, MUC1, HER2, and HSP60 autoantibodies has the potential to be investigated as an early detection biomarker for breast cancer.

Epidemiology of Newcastle disease in chickens of Ethiopia: a systematic review and meta-analysis.

The objective of this systematic review was to estimate the overall pooled prevalence of Newcastle disease in chickens in Ethiopia and identify the sources of heterogeneity among and within studies. The seroprevalence of Newcastle disease was estimated using a single-group meta-analysis. Attempts were also made to identify study-level variables that could explain the heterogeneity in the apparent seroprevalence of the Newcastle disease. The findings were based on 16 published articles and 33 district-level reports and were limited to studies performed during 2005-2017. Due to the presence of heterogeneity, pooled analysis from different districts was conducted using random-effects meta-analysis. The single-group summary of Newcastle disease seroprevalence in chickens was estimated to be 21.47% (19.54-23.4%) with a 95% confidence interval. Our results indicated high inter-study variability (Cochran's Q statistic = 196.2, true variance (τ2) = 0.36, inverse variance index (I2) = 90.0%, p < 0.001). Of all variables analysed, diagnostic techniques and regions were the most significant predictors (p ˂ 0.05) of heterogeneity. According to the diagnostic technique-based meta-analysis of random pooled prevalence, the haemagglutination inhibition test had the highest prevalence, followed by the enzyme-linked immunosorbent assay. In conclusion, the high-pooled prevalence estimates of the disease, combined with the scarcity of published data for the entire country of Ethiopia, indicate a significant data gap on the distribution of Newcastle disease in the country. While the high pooled prevalence tells the need for intervention to control the disease, there is also a need to assess the disease prevalence in all other parts of the country.

Meta-analysis of diagnostic test accuracy studies with multiple thresholds for data integration.

The objective of this study is to introduce methods to use all of the information without omission when individual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration. For diagnostic test meta-analysis, a general performance method for synthesizing data according to one cut value in one study and a performance method for synthesizing data according to two or more cut values in one study were compared and analyzed. As sample data for meta-analysis of DTA studies, 13 DTA studies on prostate cancer (34 effect sizes including total cut-offs) were collected. The summary statistics were calculated and the summary line was analyzed using the "meta", "mada", and "diagmeta" packagesof the R software. The summary statistics of the random effect model univariate analysis of the "meta" package with a single cut-off corresponding to the highest Youden index in a single study and those of the bivariate analysis of the "mada" package were highly similar. However, in the bivariate analysis of the "diagmeta" package including all cut-off values, the sensitivity decreased and the specificity increased as the amount of data increased. Considering the heterogeneity of the summary receiver op erating characteristic curve and the use of all given cut-offs, the use of the bivariate analysis model of the "diagmeta" package is recommended. This study focused on practical methods of DTA rather than theoretical concepts for use by researchers whose fields of study are non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.

Potential values of circulating tumor cell for detection of recurrence in patients of thyroid cancer: a diagnostic meta-analysis

BackgroundSeveral studies have reported that circulating tumor cells (CTCs) are a promising marker for the diagnosis of thyroid cancer (TC) with recurrence or distant metastasis (DMs). However, some studies emerged with conflicting results. Therefore, we provide a meta-analysis to evaluate the diagnostic performance of CTC for detection of recurrence in patients of TC.MethodsWe searched PubMed, Web of Science, Cochrane library with the keywords “thyroid cancer” and “circulating tumor cells”. Data extraction and risk of bias assessment were performed independently by two reviewers. The summary receiver operating characteristic curve (SROC) and other parameters were adopted to summarize the overall test performance. The sensitivity of CTCs in the detection of recurrent TC was reviewed. All analyses were performed by STATA 12.0 and Meta-disc software.ResultsFor CTCs expressing epithelial cell adhesion molecule (EpCAM), seven studies were included in our meta-analysis. Pooled sensitivity, specificity, and diagnostic odds ratio were 0.71 (95% CI: 0.63–0.78), 0.89 (95% CI: 0.84–0.94), and 26.75 (95% CI: 9.11–78.53); 0.78 (95% CI: 0.65–0.89), 0.88 (95% CI: 0.76–0.96), and 40.01 (95% CI: 10.49–152.63) for CTCs expressing thyroid stimulating hormone receptor (TSHR). The area under the SROC for EpCAM and TSHR were both 0.91.ConclusionCTC was a reliable marker for the diagnosis of TC patients with recurrence and DMs, and the sensitivity of CTCs expressing TSHR was higher than that of EpCAM. Additional research is warranted in order to establish uniformity in international guidelines, make up the drawbacks of conventional diagnostic methods and to prevent futile surgery.

The diagnostic and prognostic value of the miR-17-92 cluster in hepatocellular carcinoma: A meta-analysis

Previous studies demonstrated that microRNAs (miRNAs) could serve as biomarkers in various cancers. This meta-analysis aimed to determine the roles of a miR-17-92 cluster in hepatocellular carcinoma (HCC). Here, eligible included studies were searched through PubMed, Embase, and Wan Fang databases up to 1st February 2022. Relevant data were extracted from each eligible study to evaluate the relationship between miRNA-17-92 cluster miRNA expression and the diagnosis and prognosis of HCC. Finally, a total of 21 studies were pooled and included in the meta-analysis, of which four articles were used for diagnostic meta-analysis and eight articles were used for prognostic meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratios (DOR) of the miR17-92 cluster for diagnosis of HCC were 0.75 [95% confidence interval (CI): 0.64–0.83], 0.73 (95% CI: 0.65–0.79), and 7.87 (95% CI: 5.36–11.54), respectively. Also, the area under the curve (AUC) for the miR-17-92 cluster when diagnosing HCC was 0.79 (95% CI: 0.76–0.83). For prognostic analysis, hazard ratios (HRs) with 95% CIs were extracted from the included studies and pooled HRs were determined to assess the associations. Patients with increased expression of miR17-92 cluster miRNA were associated with poor overall survival (OS) and recurrence-free survival (RFS) (HR=1.86, 95% CI: 1.04–3.33; HR = 4.18, 95% CI: 3.02–5.77, respectively), but not progression-free survival (PFS) (HR = 0.43, 95% CI: 0.25–0.73), while no association of the miR-17-92 cluster high-expression was detected with disease-free survival (DFS) (HR: 0.95, 95% CI: 0.21–4.34). In short, current pieces of evidence suggested that the miR-17-92 cluster may serve as a novel diagnostic and prognostic biomarker for HCC. However, given the limited study number, larger-size, multi-center, and higher-quality studies are indispensable in the future.

Quantitative RECIST derived from multiparametric MRI in evaluating response of esophageal squamous cell carcinoma to neoadjuvant therapy.

To develop a quantitative Response Evaluation Criteria in Solid Tumors (qRECIST) for evaluating response to neoadjuvant therapy (nT) in ESCCs relying on multiparametric (mp) MRI. Patients with cT2-T4a/N0-N3/M0 ESCC undergoing pre-nT and post-nT esophageal mpMRI before radical resection were prospectively included. Images were reviewed by two experienced radiologists. qRECIST was redefined using four methods including conventional criterion (cRECIST) and three model-dependent RECIST relying on quantitative MRI measurements at pre-nT, post-nT, and delta pre-post nT, respectively. Pathological tumor regression grades (TRGs) were used as a reference standard. The rates of agreement between four qRECIST methods and TRGs were determined with a Cronbach's alpha test, area under the curve (AUC), and a diagnostic odds ratio meta-analysis. Ninety-one patients were enrolled. All four methods revealed high inter-reader agreements between the two radiologists, with a Kappa coefficient of 0.96, 0.87, 0.88, and 0.97 for cRECIST, pre-nT RECIST, post-nT RECIST, and delta RECIST, respectively. Among them, delta RECIST achieved the highest overall agreement rate (67.0% [61/91]) with TRGs, followed by post-nT RECIST (63.8% [58/91]), cRECIST (61.5% [56/91]), and pre-nT RECIST (36.3% [33/91]). Especially, delta RECIST achieved the highest accuracy (97.8% [89/91]) in distinguishing responders from non-responders, with 97.3% (34/35) for responders and 98.2% (55/56) for non-responders. Post-nT RECIST achieved the highest accuracy (93.4% [85/91]) in distinguishing complete responders from non-pCRs, with 77.8% (11/18) for pCRs and 94.5% (69/73) for non-pCRs. The qRECIST with mpMRI can assess treatment-induced changes and may be used for early prediction of response to nT in ESCC patients. • Quantitative mpMRI can reliably assess tumor response, and delta RECIST modelhad the best performance in evaluating response to nT in ESCCs,withan AUC of 0.98, 0.95, 0.80, and 0.82 for predicting TRG0, TRG1, TRG2, and TRG3, respectively. • In distinguishing responders from non-responders, the rate of agreement between delta RECIST and pathology was 97.3% (34/35) for responders and 98.2% (55/56) for non-responders, resulting in an overall agreement rate of 97.8% (89/91). • In distinguishing pCRs from non-pCR, the rate of agreement between MRI and pathology was 77.8% (11/18) for pCRs and 94.5% (69/73) for non- pCRs, resulting in an overall agreement rate of 91.2% (83/91).

The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis.

The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns. We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves. We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95% CI 0.71-0.92) and 0.76 (95% CI 0.56-0.89), respectively. IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention.

Limits in the search date for rapid reviews of diagnostic test accuracy studies.

Limiting the search date is a common approach utilised in therapeutic/interventional rapid reviews. Yet the accuracy of pooled estimates is unknown when applied to rapid reviews of diagnostic test accuracy studies. Data from all systematic reviews of diagnostic test accuracy studies published in the Cochrane Database of Systematic Reviews, until February 2022 were collected. Meta-analyses with at least five studies were included to emulate rapid reviews by limiting the search to the recent 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 35 and 40 years. The magnitude of the pooled area under the curve (AUC), sensitivity and specificity for the full meta-analysis and the rapid reviews were compared. A total of 846 diagnostic meta-analyses were included. When the search date was limited to the recent 10 and 15 years, more than 75% and 80% of meta-analyses presented less than 5% difference between the pooled AUC, sensitivity and specificity of the full meta-analysis and the rapid review. There was little gain in the precision of the pooled estimates when the emulated rapid reviews included more than 15 years in the search. Rapid reviews restricted by search date are a valid and reliable approach for diagnostic test accuracy studies. Robust evidence can be achieved by restricting the search date to the recent 10-15 years. Future studies need to examine the reduction in workload and time to finish the rapid reviews under different search date limits.

Small Study Effects in Diagnostic Imaging Accuracy

Small study effects are the phenomena that studies with smaller sample sizes tend to report larger and more favorable effect estimates than studies with larger sample sizes. To evaluate the presence and extent of small study effects in diagnostic imaging accuracy meta-analyses. A search was conducted in the PubMed database for diagnostic imaging accuracy meta-analyses published between 2010 and 2019. Meta-analyses with 10 or more studies of medical imaging diagnostic accuracy, assessing a single imaging modality, and providing 2 × 2 contingency data were included. Studies that did not assess diagnostic accuracy of medical imaging techniques, compared 2 or more imaging modalities or different methods of 1 imaging modality, were cost analyses, used predictive or prognostic tests, did not provide individual patient data, or were network meta-analyses were excluded. Data extraction was performed in accordance with the PRISMA guidelines. The diagnostic odds ratio (DOR) was calculated for each primary study using 2 × 2 contingency data. Regression analysis was used to examine the association between effect size estimate and precision across meta-analyses. A total of 31 meta-analyses involving 668 primary studies and 80 206 patients were included. Fixed effects analysis produced a regression coefficient for the natural log of DOR against the SE of the natural log of DOR of 2.19 (95% CI, 1.49-2.90; P < .001), with computed tomography as the reference modality. Interaction test for modality and SE of the natural log of DOR did not depend on modality (Wald statistic P = .50). Taken together, this analysis found an inverse association between effect size estimate and precision that was independent of imaging modality. Of 26 meta-analyses that formally assessed for publication bias using funnel plots and statistical tests for funnel plot asymmetry, 21 found no evidence for such bias. This meta-analysis found evidence of widespread prevalence of small study effects in the diagnostic imaging accuracy literature. One likely contributor to the observed effects is publication bias, which can undermine the results of many meta-analyses. Conventional methods for detecting funnel plot asymmetry conducted by included studies appeared to underestimate the presence of small study effects. Further studies are required to elucidate the various factors that contribute to small study effects.

Salivary noncoding RNA in the diagnosis of pancreatic cancer: Systematic review and meta-analysis.

Pancreatic cancer is considered one of the most deadly malignancies, primarily because of its diagnostic challenges. We performed a systematic review and diagnostic meta-analysis to evaluate the diagnostic value of noncoding salivary RNAs in pancreatic cancer diagnosis. Our investigation involved pertinent studies published in PubMed, Scopus, Web of Science, LIVIVO, Ovid and also the Google Scholar search engine. Specificity and sensitivity were calculated, as were positive and negative likelihood ratios (PLR and NLR), and the diagnostic odds ratio (DOR). The summary receiver-operating characteristics and area under the curve were plotted and assessed. This meta-analysis and systematic review involved and examined five studies that contained 145 study units with a total of 2731 subjects (1465 pancreatic cancer patients versus 1266 noncancer controls). The pooled specificity, sensitivity, NLR, PLR and DOR were 0.783 (95% CI: 0.759-0.805), 0.829 (95% CI: 0.809-0.848), 0.309 (95% CI: 0.279-0.343), 3.386 (95% CI: 2.956-3.879) and 18.403 (95% CI: 14.753-22.954), respectively, with the area under the curve (AUC) equal to 0.882. Subgroup analyses were conducted based on the saliva type (unstimulated and stimulated), mean age of patients, sample size, type of control, serum carbohydrate antigen 19-9 (CA19-9) level and type of salivary noncoding RNA (microRNA (miRNA) and long noncoding RNA (lncRNA)). The results of our systematic review and meta-analysis suggest that noncoding RNA biomarkers in the stimulated saliva could be a promising approach for accurate pancreatic cancer diagnosis in the early stages.

Evidence-based insights on ideal blanking period duration following atrial fibrillation catheter ablation.

Despite the general adoption of a 3-month blanking period (BP), increasing scientific evidence suggests an association between early recurrences of atrial tachyarrhythmias (ERAT) and failure of atrial fibrillation catheter ablation (AFCA). The aim of the present study was to perform a diagnostic meta-analysis to derive the ideal BP cut-off following AFCA. PubMed/MEDLINE databases were screened for articles reporting late recurrences of atrial tachyarrhythmias (LRAT) in AFCA patients experiencing an ERAT (with at least one time cut-off). Seventeen studies were finally included in the analysis, encompassing 5837 AF patients experiencing ERAT after AFCA. A random-effect meta-analysis of diagnostic test accuracy studies with multiple cut-offs was performed. The day at which the ERAT occurred was considered the diagnostic 'test', whereas the different time cut-offs reported in the singular studies were treated as cut-offs of interest in the meta-analysis. Overall, a 27.7 day (95% confidence interval: 10.4-45.1 days) cut-off was identified as the optimal BP duration [area under the summary receiver operating characteristic (AUC-SROC) curve: 0.66, 95% CI: 0.56-0.75]. Specificity (95% CI: 63-85%) and positive predictive value were 76%. At subgroup analysis, the optimal BP cut-off was 39.0 days (95% CI: 26.8-51.2 days, AUC-SROC: 0.63) following radiofrequency AFCA and 30.1 days (95% CI: 0-63.4 days, AUC-SROC: 0.76) after cryoballoon ablation. The present meta-analysis indicates that a 4-week BP represents the optimal cut-off following AFCA. Altogether, these meta-analytic insights support the need of a revision of the actual 3-month BP duration.

Accuracy of the "International Criteria" for ECG screening in athletes in comparison with previous published criteria: rationale and design of a diagnostic meta-analysis.

The impact of the International Criteria for ECG interpretation in athletes has further improved the diagnostic accuracy of the 12-lead ECG use for preparticipation screening (PPS); moreover, these criteria have been evaluated in different populations of athletes and settings proving good results. We aimed to perform a comprehensive review of the use of the International Criteria for ECG interpretation in athletes, stemming from a systematic review to diagnostic meta-analysis, limiting our inclusion only to observational studies to determine the diagnostic accuracy of ECG for detecting cardiac anomalies related to sudden cardiac death in athletes. This meta-analysis is expected to include several important studies related to PPS on different populations of athletes comparing different ECG criteria and detail important data on the diagnostic accuracy of ECG in PPS. Furthermore, we intend to highlight the advantage of using ECG in PPS. The present diagnostic meta-analysis results will aid sports medicine physicians and cardiologist in adhering to the most accurate criteria for ECG evaluation in athletes and it may help to solve controversies aroused regarding the excess cost of ECG in PPS related to the amount of false positive cases.

Performance of deep learning in the detection of intracranial aneurysm: A systematic review and meta-analysis

PurposeEarly detection and diagnosis of intracranial aneurysms (IAs) are particularly critical. Deep learning models (DLMs) are now widely used in the diagnosis of various diseases.Different DLMs have been developed to detect IAs. However, the overall performance of various DLMs for detecting IAs has not been evaluated. We aimed at exploring the performance of DLMs in the detection of IAs and measuring the effect of DLMs in assisting clinicians. MethodsA diagnostic accuracy meta-analysis using a mixed-effect binary regression model was performed to estimate accuracy in patient-level and lesion-level. Moreover, the effect in assisting clinicians was measured by a random-effect meta-analysis. ResultsTwenty cohort studies including a total of 17 DLMs were assessed eligible in the present study. We summarized that DLMs had both high sensitivity (0.92, 95 % CI: 0.85 to 0.96) and specificity (0.96, 95 % CI: 0.94 to 0.97) in the detection of IAs in patient-level. In lesion-level, we also found a high summary sensitivity of 0.92 (95 % CI: 0.87 to 0.95). Moreover, assisted by DLMs, the sensitivity of clinicians became higher (Risk ratio: 1.09, P-value: 0.0006), with no effect on the specificity in diagnosis (Risk ratio: 0.99, P-value: 0.53). The reading time was reduced by the assistance of the deep learning model. (Mean difference: −7.37, P-value: 0.0077) ConclusionsDLMs have the competence of detecting IAs accurately. Moreover, DLMs can improve clinicians’ sensitivity and reduce the reading time without affecting the specificity in diagnosing IAs.

Diagnostic and prognostic value of microRNA-486 in patients with lung cancer: A systematic review and meta-analysis.

There are conflicting opinions on whether miR-486 could be used for cancer diagnosis and prognosis. Therefore, this present study investigated the potential effect of miR-486 on lung cancer diagnosis and prognosis. We researched PubMed, Embase, Wanfang and Chinese National Knowledge Infrastructure databases to select relevant publications. Specificity and sensitivity were obtained for the pooled and subgroup diagnostic meta-analysis while the hazard ratio was for prognostic meta-analysis. Publication analyses and sensitivity analyses were conducted to investigate possible sources of heterogeneity. The overall sensitivity and specificity with 95% confidence intervals were 0.8 (0.8-0.9) and 0.9 (0.9-0.9). Results of subgroup analysis showed that high diagnostic efficacy might be obtained by miR-486 combined with other microRNAs (area under the curve (AUC): 0.9 (0.9-1.0)) to distinguish lung cancer patients from healthy controls (AUC: 1.0 (0.9-1.0)), especially for lung adenocarcinoma (AUC: 1.0 (1.0-1.0)) in the Asian population (AUC: 0.9 (0.9-1.0)). For prognosis prediction of miR-486 in overall non-small cell lung cancer, the overall hazard ratio with 95% confidence interval was 1.15 (0.85-1.54) for high versus low expression of miR-486, which indicated that a high miR-486 level was not related to the high risk of poor outcome. However, for the subgroup of progression-free survival and patients with chemotherapy, the hazard ratio was 0.41 (0.21-0.77), indicating that the higher miR-486 level would decrease the risk of poor progression-free survival for lung cancer patients with chemotherapy. This study suggested circulating miR-486 combined with other microRNAs could be used as ideal biomarkers in early diagnosis and prognosis prediction for lung cancer, especially for lung adenocarcinoma in the Asian population.

The diagnostic value of exosomal circular RNAs in cancer patients: A systematic review and meta-analysis.

Recently, serum exosomal circular RNAs (circRNAs) were applied to discriminate cancer patients from healthy individuals, indicating that exosomal circRNAs have the potential to be novel biomarkers for cancer diagnosis. This study aims to summarize the role of exosomal circRNAs in cancer diagnosis by a meta-analysis. A comprehensive literature search was conducted up to July 2021 in PubMed, Web of Science, EMBASE, and Cochrane Database. To evaluate the diagnostic value, the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were pooled. Threshold effect followed by subgroup analysis and meta-regression were performed to explore the source of heterogeneity. Sensitivity analysis was performed to assess the stability of this meta-analysis model. Fagan plots and likelihood ratio scattergrams were used to explore the potential clinical significance. Ten eligible studies with 514 controls and 557 patients were included in this diagnostic meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.75 (95% CI: 0.65-0.83), 0.84 (95% CI, 0.78-0.89), 5.87 (95% CI, 3.67-9.38), 0.28 (95% CI, 0.19-0.40), and 21.15 (95% CI, 10.25-43.68), respectively. The AUC was 0.89 (95% CI, 0.86-0.91). Sensitivity analysis showed that four studies had an impact on the pooled results and mainly contributed to the heterogeneity. Fagan's nomogram revealed that the prior probability of 20%, the post probability positive, the post probability negative were 59% and 6%, respectively. Our results suggested that exosomal circRNAs might serve as powerful biomarkers in detecting cancers with high sensitivity and specificity. However, more well-designed and multicenter diagnostic tests are needed to validate our results.

Molecular Tools for Guiding Therapy in Patients With Staphylococcal Bone and Joint Infections: A Diagnostic Test Accuracy Meta-analysis.

BackgroundTimely detection of causative pathogens and their antimicrobial resistance are essential for guiding targeted therapies in bone and joint infections (BJI) patients. We performed a systematic review and meta-analysis to assess the diagnostic value of testing osteoarticular samples with the nucleic acid amplification tests (NAAT) for effective staphylococcal strain identification and the administration of appropriately targeted antimicrobial agents in BJI patients.MethodsFive databases, including PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, were searched for related publications from inception to July 24, 2021. Studies comparing the diagnostic accuracy of NAAT to a microbiological culture reference standard of osteoarticular specimens were eligible. Pooled summary values of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) of NAAT compared to the microbiological culture reference standard were calculated using bivariate random-effects meta-analyses.ResultsFrom 906 citations, 11 studies were included. Eleven studies comprising 13 datasets (n = 1047) evaluated NAAT accuracy for methicillin-sensitive Staphylococcus aureus (MSSA) identification, while seven studies comprising nine datasets (n = 727) evaluated methicillin-resistant Staphylococcus aureus (MRSA) identification. Against the microbiological culture reference standard, the pooled summary estimates for detection of both MSSA [sensitivity: 0.89 (95% confidence interval [CI] 0.84–0.93), specificity: 0.99 (95% CI 0.97–0.99), PLR: 34.13 (95% CI 20.54–56.73), NLR: 0.19 (95% CI 0.12–0.3), and DOR: 283.37 (95% CI 129.49–620.1)] and MRSA [sensitivity: 0.81 (95% CI 0.67–0.91), specificity: 1.0 (95% CI 0.99–1.0), PLR: 62.1 (95% CI 24.5–157.6), NLR: 0.33 (95% CI 0.16–0.69), and DOR: 300.25 (95% CI 85.01–1060.5)] were comparable. Heterogeneity was moderate. GeneXpert was frequently used among NAA tests, and its diagnostic accuracy was in line with the overall pooled summary estimates. The heterogeneity in diagnostic efficacy (P >0.05) could not be explained by a meta-regression and subgroup analysis of the research design, sample condition, and patient selection technique.ConclusionsOur study suggested that NAAT can be applied as the preferred prescreening test for the timely diagnosis of staphylococcal strains associated with BJI in osteoarticular samples for successful antimicrobial therapy.

Circulating microRNAs as Potential Biomarkers for the Diagnosis of Endometrial Cancer: a Meta-Analysis.

Endometrial cancer (EC) is the most common female genital tract malignancy worldwide. Many investigators have confirmed the possibility of using circulating miRNAs to diagnose EC; however, the results were inconsistent. Therefore, we performed the current meta-analysis to systematically evaluate the diagnostic value of circulating miRNAs in EC. We carefully searched relevant articles published prior to February 15, 2022 in the databases of PubMed, Embase, Web of Science, Cochrane Library, Wanfang database, and China National Knowledge Infrastructure (CNKI) based on PRISMA statement. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to test the diagnostic accuracy. Furthermore, subgroup analyses were performed to identify the potential sources of heterogeneity, and the Deeks' funnel plot asymmetry test was used to evaluate the potential publication bias. Twenty-one studies from 12 articles including a total of 2305 participants (1341 EC patients and 964 controls) were included in the current diagnostic meta-analysis. The overall pooled results of miRNA for EC diagnosis were: sensitivity, 0.84 (95% CI: 0.79-0.88); specificity, 0.87 (95% CI: 0.79-0.91); PLR, 6.3 (95% CI: 3.9-10.0); NLR, 0.18 (95% CI: 0.13-0.25); DOR, 35 (95% CI: 17-71); and AUC was 0.91 (95% CI: 0.89-0.94). Subgroup analysis suggested that miRNA cluster, serum type, and large sample sizes showed a better diagnostic accuracy. Moreover, there was no significant publication bias. Circulating miRNAs have great potential as novel non-invasive biomarkers for EC diagnosis.