Diagnostic OR Research Articles

Detecting Manifestations of Neurofibromatosis: Cutaneous Diagnostic Criteria for NF1 and NF2

Neurofibromatosis is a hereditary condition that causes tumors to form in the brain, spinal cord, and nerve regions. Neurofibromatosis Type 1 (NF1) and Neurofibromatosis Type 2 (NF2) are the two of the most common subtypes. We performed a literature review on Pubmed under the following search and included the 24 most cited papers between 2012 and 2024: “Neurofibromatosis AND (Cutaneous OR Skin) AND (Diagnostic Criteria OR Diagnosis) AND (NF1 OR NF2)”. In our review, both types can manifest cutaneous symptoms, which aid in early detection. Between the two types, NF1 is more common with an estimated prevalence of 1 in 3000, compared to NF2’s 1 in 60,000. NF1 is distinguished by café-au-lait spots, freckling, and neurofibromas; NF2 presents similar to NF1 but may also have characteristic bilateral vestibular schwannomas. While both conditions may exhibit cutaneous manifestations, NF1 primarily presents with such features, whereas NF2 is distinguished by intracranial manifestations. Early detection of cutaneous symptoms is critical for prompt intervention and management of neurofibromatosis. More research is needed to elucidate the detection of neurofibromatosis in clinical practice as differentiation may be challenging.

A systematic review of the predictive value of radiomics for nasopharyngeal carcinoma prognosis.

Radiomics has been widely used in the study of tumours, which has predictive and prognostic value in nasopharyngeal carcinoma (NPC). Therefore, we collected relevant literature to explore the role of current radiomics in predicting the prognosis of NPC. We performed a systematic literature review and meta-analysis in accordance with the preferred reporting items in the systematic evaluation and meta-analysis guidelines. We included papers on radiomics published before May 5, 2024, to evaluate the predictive ability of radiomics for the prognosis of NPC. The methodological quality of the included articles was evaluated using the radiomics quality score. The area under the curve (AUC), combined sensitivity and combined specificity were used to evaluate the ability of radiomics models to predict the prognosis of NPC. A total of 20 studies met the inclusion criteria for the current systematic review, and 13 papers were included in the meta-analysis. The radiomics quality score ranged from 7 to 20 (maximum score: 36). The diagnostic test forest plots showed that the diagnostic OR of radiology was 11.04 (95% CI: 5.11-23.87), while the ORs for sensitivity and 1-specificity were 0.75 (95% CI: 0.73-0.78) and 0.74 (95% CI: 0.72-0.76), respectively. It cannot be determined whether the combined model was superior to the radiomics model for predicting the prognosis of NPC. It is unclear whether the fact that the radiomics model was composed of features extracted from MRI is due to CT. The AUC of PFS was larger than that of disease-free survival (P < .05). The overall AUC value is 0.8265. This study summarized all the studies that examined the predictive value of radiomics for NPC prognosis. Based on the summarized AUC values, as well as sensitivity and 1-specificity, it can be concluded that radiomics has good performance in predicting the prognosis of NPC. Radiomics models have certain advantages in predicting the effectiveness of PFS compared to predicting disease-free survival. It cannot be determined whether the combination model is superior to the radiomics model in predicting NPC prognosis, nor can it be determined whether imaging methods have differences in predictive ability. The findings confirmed and provided further evidence supporting the effectiveness of radiomics for the prediction of cancer prognosis.

Abstract PO4-27-10: A Systematic Review and Meta-analysis of Diagnostic Performance of Fluorescein Guided Sentinel Lymph Node Biopsy in Early Breast Cancer

Abstract Background: Evaluation of axillary lymph nodes status in cN0 axilla is performed by sentinel lymph node biopsy (SLNB) utilizing a combination of radioactive isotope and blue dye. There is a paucity of radioactive tracer in many countries of transitional economies. Hence, alternatives to isotope have been explored, viz. indocyanine green (ICG), superparamagnetic iron oxide nanoparticles and Fluorescein Sodium (FS). This systematic review and meta-analysis, evaluates the diagnostic performance of Fluorescein Sodium guided SLNB. Objectives: The objective was to evaluate the diagnostic performance of Fluorescein Sodium for sentinel lymph node biopsy in early breast cancer. Methods: PRISMA 2020 guidelines were followed for this meta-analysis. Eligibility criteria: Studies where SLNB was performed using Fluorescein Sodium for breast carcinoma. Information sources: PubMed, EMBASE, Cochrane library and online clinical trial registers Risk of bias: Articles were assessed for risk of bias using the QUADAS-2 tool. Synthesis of results: The main summary measures were pooled detection rate and pooled false negative rate using random effects model. In order to describe heterogeneity, we constructed summary receiver operating characteristic (SROC) curves with 95% prediction regions, estimated using bivariate meta-analysis with a test level random effect only, and forest plots. Calculations were performed using the Meta-Disc v1.4 program (available from https://metadisc.software.informer.com/1.4/). Results: Out of 45 studies found on initial systematic search, 7 studies were found eligible and were included in the meta-analysis based on data on 332 patients. The pooled detection rate was 93.2% (95% confidence interval [CI] 87% to 97%).). The heterogeneity (I2 value) of the pooled detection rate was 71%. Five validation studies were included for pooling the false negative rate (FNR) and included a total of 211 patients. The pooled FNR was 5.6% (95% CI; 2.9 to 9.07). Five validation studies were included for sensitivity, specificity, diagnostic odds ratio, LR+ and LR- meta-analysis. With regards to the identification of SLN the pooled sensitivity was 80% [(95% CI, 68% to 89%); I2=79.8]; specificity was 98% [(95% CI, 95% to 100%); I2=0.0]. The likelihood ratio for a positive test LR+ was 23.2 [(95% CI, 5.91 to 95.18); I2=0.0] and likelihood ratio for a negative test a LR- of 0.41 [(95% CI, 0.16 to 1.05); I2=88.1]. The diagnostic Odds ratio OR was 76.94 (95% CI, 15.88 to 372.79). Diagnostic accuracy as measured by SROC was 99.08%. Q index was 0.96. Publication bias for pooled detection rate as per Egger’s test was -2.2 (p= 0.66) and for FNR was 1.85 (p=0.29). Visual inspection of summary ROC curve and of forest plots did not show significant heterogeneity. Conclusion: Fluorescein guided SLNB is an affordable option for detection of lymph node metastases in cN0 patients with early breast cancer. It achieves a high detection rate of 93% with a false negative rate of 5.6% for the detection of axillary lymph node metastasis. We recommend larger multinational trials to confirm its high detection rate with low false negativity. Citation Format: Sanjay Kumar Yadav, Bharath S, Sarada Khadka, Dhananjaya Sharma, Chandan Kumar Jha, Gaurav Agarwal, Manju Singh, Anurag Srivastava, Amit Goyal. A Systematic Review and Meta-analysis of Diagnostic Performance of Fluorescein Guided Sentinel Lymph Node Biopsy in Early Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-10.

Diagnostic values of contrast-enhanced MRI and contrast-enhanced CT for evaluating the response of hepatocellular carcinoma after transarterial chemoembolisation: a meta-analysis

ObjectivesTo assess and compare the diagnostic value of contrast-enhanced MRI (CEMRI) and contrast-enhanced CT (CECT) for evaluating the response of hepatocellular carcinoma (HCC) after transarterial chemoembolisation (TACE).DesignSystematic review and meta-analysis.Data...

Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: study protocol

IntroductionVertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist....

Diagnostic predictive values for sport-related concussions: a systematic review and diagnostic meta-analysis.

Sport-related concussions (SRCs) can cause significant neurological symptoms, and approximately 10%-15% of athletes with SRC experience a prolonged recovery. Given the lack of visible injury on brain imaging and their varied presentations, concussions can be difficult to diagnose. A variety of tests and examination methods have been used to elicit a concussion diagnosis; however, the sensitivity and specificity of these tests are variable. The authors performed a systematic review and meta-analysis to evaluate the sensitivity and specificity of standardized tests and visible signs like balance and vision changes in the diagnosis of SRC. A PRISMA-adherent systematic review of concussion diagnostic examinations was performed using the PubMed, MEDLINE, Scopus, Cochrane, Web of Science, and Google Scholar databases on December 1, 2022. Search terms included "concussion," "traumatic brain injury," "diagnosis," "sensitivity," and "specificity." Each method of examination was categorized into larger group-based symptomatologic presentations or standardized tools. The primary outcome was the diagnosis of concussion. Pooled specificity and sensitivity for each method were calculated using a meta-analysis of proportion and were hierarchically ranked using P-scores calculated from a diagnostic frequentist network meta-analysis. Thirty full-length articles were identified for inclusion, 13 of which evaluated grouped symptomology examinations (balance and overall clinical presentation) and 17 of which evaluated established formalized tools (ImPACT, King-Devick [K-D] Test, Sport Concussion Assessment Tool [SCAT]). The pooled specificity of the examination methods differed minimally (0.8-0.85), whereas the sensitivity varied to a larger degree (0.5-0.88). In a random effects model, the SCAT had the greatest diagnostic yield (diagnostic OR 31.65, 95% CI 11.06-90.57). Additionally, P-score hierarchical ranking revealed SCAT as having the greatest diagnostic utility (p = 0.9733), followed sequentially by ImPACT, clinical presentation, K-D, and balance. In deciphering which concussion symptom-focused examinations and standardized tools are most accurate in making a concussion diagnosis, the authors found that the SCAT examination has the greatest diagnostic yield, followed by ImPACT, clinical presentation, and K-D, which have comparable value for diagnosis. Given the indirect nature of this analysis, however, further comparative studies are needed to validate the findings.

Prediction of Surgical Outcomes in Normal Pressure Hydrocephalus by MR Elastography.

Normal pressure hydrocephalus is a treatable cause of dementia associated with distinct mechanical property signatures in the brain as measured by MR elastography. In this study, we tested the hypothesis that specific anatomic features of normal pressure hydrocephalus are associated with unique mechanical property alterations. Then, we tested the hypothesis that summary measures of these mechanical signatures can be used to predict clinical outcomes. MR elastography and structural imaging were performed in 128 patients with suspected normal pressure hydrocephalus and 44 control participants. Patients were categorized into 4 subgroups based on their anatomic features. Surgery outcome was acquired for 68 patients. Voxelwise modeling was performed to detect regions with significantly different mechanical properties between each group. Mechanical signatures were summarized using pattern analysis and were used as features to train classification models and predict shunt outcomes for 2 sets of feature spaces: a limited 2D feature space that included the most common features found in normal pressure hydrocephalus and an expanded 20-dimensional (20D) feature space that included features from all 4 morphologic subgroups. Both the 2D and 20D classifiers performed significantly better than chance for predicting clinical outcomes with estimated areas under the receiver operating characteristic curve of 0.66 and 0.77, respectively (P < .05, permutation test). The 20D classifier significantly improved the diagnostic OR and positive predictive value compared with the 2D classifier (P < .05, permutation test). MR elastography provides further insight into mechanical alterations in the normal pressure hydrocephalus brain and is a promising, noninvasive method for predicting surgical outcomes in patients with normal pressure hydrocephalus.

TVS-guided cervical strain elastography is more effective than measuring cervical length as an independent predictor of spontaneous preterm delivery in asymptomatic, high-risk women during the mid-trimester

Introduction TVS (Transvaginal Sonography) guided Cervical strain elastography (CSE) is now available in tertiary referral centers of LMICs (Low- and Middle-Income Countries). TVS cervical length (CL) assessment is being used routinely. Still, elastography is not used in clinical settings, although enough evidence suggests good predictive value towards sPTD (spontaneous Preterm Delivery). The clinical utility of elastography has not been tested among high-risk populations of LMICs for the prediction of sPTD. Aim To test the performance of TVS-CSE in predicting sPTD among asymptomatic women in the mid-trimester at risk of sPTD either due to clinical factors or due to a short cervix. Method Prospective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24 weeks who had one or more clinical risk factors for sPTD or CL <2.5 cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR – softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37 weeks (after 26 weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM—was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length. Results Out of 221 recruited,17 were lost to follow-up after 32 weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5 cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63 ± 0.67 vs. 3.63 ± 0.80, p = .981) whereas SRs in all three ROIs were significantly lower among sPTD group versus no sPTD group (IN:0.65 ± 0.29 vs 0.79 ± 0.30 p = .001, WN:0.34 ± 0.13 vs 0.39 ± 0.15, p = .013, AN:0.37 ± 0.16 vs 0.48 ± 0.26, p = .002, respectively). Using ROC curves, while CL was not predictive (AUROC 0.49, p = .81), SRs showed moderate predictive value toward sPTD with the best AUC of 0.624 (p = .003) at IN. Prediction was slightly better for early sPTD <32 weeks (AUC 0.653 p = 0.03). The best cutoff for SR at IN was 0.72, below which there was a moderate accuracy in predicting sPTD (sensitivity 52.11%, specificity 60.9%, PPV 41.57%, NPV 70.44%, diagnostic OR 1.69 and overall accuracy of 57.84%). A weak positive correlation is seen between IN and CL (Pearson’s correlation R = 0.181). Multi-variable binary logistic regression analysis suggested that SRs at IN (Adjusted OR − 0.259 CI 0.079–0.850), AN (Adjusted OR 0.182 CI 0.034–0.963), Multiple Pregnancy (Adjusted OR 3.5 CI 1.51–8.13) and previous sPTD/PPROM (Adjusted OR 2.72 CI 0.97–7.61) independently predicted sPTD. Conclusions TVS CSE performed better than CL as an independent predictive tool toward sPTD, although predictive efficacy was modest at best. Since technology is now available in high-end USG machines in tertiary care centers, we propose optimal utilization of CSE in LMICs to triage at-risk populations since low SRs are strongly associated with sPTD.

Diagnostic utility of serum IgG4 level in IgG4-related diseases: a comprehensive systematic review and meta-analysis

BackgroundDespite many studies suggesting an association between serum IgG4 and IgG4-related diseases (IgG4-RD), the evidence of the utility of serum IgG4 titres in differentiating between IgG4-RD and non-IgG4-RD remains uncertain.MethodsThe...

Ratios from full blood count as markers for TB diagnosis, treatment, prognosis: a systematic review.

BACKGROUND: The monocyte-to-lymphocyte (MLR) and neutrophil-to-lymphocyte (NLR) ratio are calculated from routine full blood counts. The aim of this study was to systematically review MLR and NLR as biomarkers for diagnosis, treatment response monitoring and prognostic biomarker for TB infection or disease.METHODS: A systematic literature search was conducted in Medline, Embase and the Cochrane Library on 12 January 2022. The following search terms were used: tuberculosis AND (monocyte OR neutrophils), AND lymphocytes AND (diagnostic OR prognostic OR treatment).RESULTS: A total of 2,314 studies were identified, of which 41, covering 11,952 individuals, were included in the final analysis. Studies enrolled a median of 154 individuals (IQR 108-301). Increased MLR and NLR were associated with TB disease when compared to healthy controls and individuals with TB infection. MLR was shown to be prognostic for progression to TB disease and to decrease in response to TB treatment. The cut-offs determined in the studies were highly variable for MLR and NLR, making it impractical to conduct a meta-analysis of sensitivity and specificity.CONCLUSION: Higher MLR and NLR are associated with TB disease and could be used as easy-to-obtain, low-cost additional diagnostic biomarkers. Further studies investigating these biomarkers are needed.

Sex-specific diagnostic efficacy of MRI in axial spondyloarthritis: challenging the ‘One Size Fits All’ notion

ObjectivesSex-specific differences in the presentation of axial spondyloarthritis (axSpA) may contribute to a diagnostic delay in women. The aim of this study was to investigate the diagnostic performance of MRI...

Diagnostic and therapeutic approaches for endometriosis: a patent landscape.

The aim of this review is to analyze the patent filings and to systematize the main technological trends in patent protection for the diagnosis and therapeutics for endometriosis. Patent literature has also been explored to identify active inventors and applicants in this field. Patent search was carried out in the freely accessible patent search databases namely, patentscope using various combinations of the keywords "Endometriosis OR Adenomyosis" AND "Diagnostic OR Therapeutics" were used along with wildcard search queries in the "Title", "Abstract" and "Descriptions" fields. A patent search revealed 144 patents describing inventions for diagnostic and therapeutic purposes of endometriosis. These patents include 26 patent applications in the diagnostic utility and 116 patent applications under the therapeutic approaches. Out of these 116 patent applications, 43 describe traditional medicines for endometriosis. Two patent applications describe inventions that can fall into both categories. Efforts are being made to improve current diagnostic instruments.Hormonal alteration methods is the most common field of invention, followed by surgical interventions for therapeutics. A general trend of increase in patent application filings has been observed with a slight decrease in recent years.

Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis

ObjectiveThe first biomarker associated with the rheumatoid arthritis is rheumatoid factor (RF) and since the earliest reports a role has been proposed in the diagnosis and in the prediction of...

Diagnostic accuracy of different ECG-based algorithms in wide QRS complex tachycardia: a systematic review and meta-analysis

ObjectiveSeveral ECG-based algorithms have been proposed to enhance the effectiveness of distinguishing Wide QRS complex tachycardia (WCT), but a comprehensive comparison of their accuracy is still lacking. This meta-analysis aimed...

Computed tomography-derived membranous septum length as predictor of conduction abnormalities and permanent pacemaker implantation after TAVI: A meta-analysis of observational studies.

Permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is associated with higher risk of mortality and rehospitalization for heart failure. Efforts to prevent conduction abnormalities (CA) requiring PPI after TAVI should be made. The membranous septum (MS) length and its interaction with implantation depth (ID-ΔMSID) could provide useful information about the risk of CA/PPI following TAVI. To identify MS length and ΔMSID as predictors of CA/PPI following TAVI. Study-level meta-analysis of studies published by September 30, 2022. Eighteen studies met our eligibility including 5740 patients. Shorter MS length was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: odds ratio [OR] 1.60, 95% confidence interval [CI] 1.28-1.99, p < 0.001). Similarly, lower ΔMSID was associated with a significantly higher risk of CA/PPI (per 1 mm decrease: OR 1.75, 95%CI 1.32-2.31, p < 0.001). Meta-regression analyses revealed a statistically significant modulation of the effect of shorter MS length and lower ΔMSID on the outcome (CA/PPI) by balloon postdilatation (positive regression coefficients with p < 0.001); with increasing use of balloon postdilatation, the effect of shorter MS length and lower ΔMSID on the outcome increased. MS length and ΔMSID demonstrated excellent discriminative abilities, with diagnostic ORs equaling 9.49 (95%CI 4.73-19.06), and 7.19 (95%CI 3.31-15.60), respectively. Considering that short MS length and low ΔMSID are associated with higher risk of CA and PPI, we should include measurement of MS length in the pre-TAVI planning with MDCT and try to establish optimal ID values before the procedure to avoid CA/PPI.

Diagnostic accuracy of cryptococcal antigen test in pulmonary cryptococcosis: a protocol for a systematic review and meta-analysis

BackgroundThe cryptococcal antigen (CrAg) test was proposed as a rapid diagnostic tool to identify cryptococcal meningitis in patients suffering from AIDS. Several studies have demonstrated its diagnostic performance in cryptococcal...

Validation of algorithms to select patients with multiple myeloma and patients initiating myeloma treatment in the national Veterans Affairs Healthcare System.

We aimed to evaluate and compare the performance of multiple myeloma (MM) selection algorithms for use in Veterans Affairs (VA) research. Using the VA Corporate Data Warehouse (CDW), the VA Cancer Registry (VACR), and VA pharmacy data, we randomly selected 500 patients from 01/01/1999 to 06/01/2021 who had (1) either one MM diagnostic code OR were listed in the VACR as having MM AND (2) at least one MM treatment code. A team reviewed oncology notes for each veteran to annotate details regarding MM diagnosis and initial treatment within VA. We evaluated inter-annotator agreement and compared the performance of four published algorithms (two developed and validated external to VA data and two used in VA data). A total of 859 patients were reviewed to obtain 500 patients who were annotated as having MM and initiating MM treatment in VA. Agreement was high among annotators for all variables: MM diagnosis (98.3% agreement, Kappa=0.93); initial treatment in VA (91.8% agreement; Kappa=0.77); and initial treatment classification (87.6% agreement; Kappa=0.86). VA Algorithms were more specific and had higher PPVs than non-VA algorithms for both MM diagnosis and initial treatment in VA. We developed the "VA Recommended Algorithm," which had the highest PPV among all algorithms in identifying patients diagnosed with MM (PPV=0.98, 95% CI=0.95-0.99) and in identifying patients who initiated their MM treatment in VA (PPV=0.93, 95% CI=0.90-0.96). Our VA Recommended Algorithm optimizes sensitivity and PPV for cohort selection and treatment classification.

Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis

ObjectivesThe purpose of this study was systematically and quantitatively to assess the value of the neutrophil-to-lymphocyte ratio (NLR) for the diagnosis of neonatal sepsis by systematic review and meta-analysis.DesignSystematic review...

Comprehensive analysis of multivariable models for predicting severe dengue prognosis: systematic review and meta-analysis.

Dengue fever has often been confused with other febrile diseases, with deterioration occurring in the later state. Many predictive models for disease progression have been developed, but there is no definite statistical model for clinical use yet. We retrieved relevant articles through Global Health, EMBASE, MEDLINE and CINAHL Plus. The Prediction Model Risk of Bias Assessment Tool was adopted to assess potential bias and applicability. Statistical analysis was performed using Meta-DiSc software (version 1.4). Of 3184 research studies, 22 were included for the systematic review, of which 17 were selected for further meta-analysis. The pooled data of predictive accuracy was as follows: the sensitivity was 0.88 (95% CI 0.86 to 0.89), the specificity was 0.60 (95% CI 0.59 to 0.60), the positive likelihood ratio was 2.83 (95% CI 2.38 to 3.37), the negative likelihood ratio was 0.20 (95% CI 0.14 to 0.0.29) and the diagnostic OR was 16.31 (95% CI 10.25 to 25.94). The area under the summary receiver operating characteristic curve value was 0.86 (SE=0.02) with 0.79 (SE=0.02) of the Cochran Q test value. The overall predictive power of models in this study was relatively high. With careful adaption and standardization, the implementation of predictive models for severe dengue could be practical in actual clinical settings.

Adapted echocardiography screening methods for prevention of rheumatic heart disease in Sub-Saharan Africa: a systematic review

Echocardiography is the current gold standard used in diagnosing rheumatic heart disease and its associated sequelae, but utilization is currently limited in resource-poor settings. Decentralized diagnostic methods in these areas are crucial to improving cardiac health outcomes. A systematic review was undertaken to evaluate the diagnostic performance of adapted echocardiography screening methods in countries of sub-Saharan Africa. A literature search was conducted via the PubMed, Embase, and African Healthline databases. Studies were included in the review if they assessed the diagnostic accuracy of an adapted screening method as compared to the reference standard of hospital-based echocardiogram by trained cardiologists. Diagnostic performances of handheld echocardiography and task-shifting to non-physician roles, were assessed. For HAND techniques, the pooled sensitivity, specificity and diagnostic odds ratio was 81.2%, 91.7%, and 48.01% respectively. Task-shifting and simplified protocol diagnostic performance was also analyzed; pooled sensitivity, specificity and diagnostic OR was 74.8%, 89.5%, and 25.37% respectively. This review demonstrates strong specificity with moderate sensitivity among both methods of adapted screening. HAND methods using the standard prescribed WHO protocol had stronger diagnostic performance overall. These studies present a first step towards validating current echocardiographic screening criteria using hand-held machines and establishing training of non-physicians to conduct screening in low-resource settings.