Utility of Routine Frozen Section of Thyroid Nodules Classified as Follicular Neoplasm

2019 ◽  
Author(s):  
Jhorman Grisales ◽  
Alvaro Sanabria
Keyword(s):  
Quality Assessment ◽  
Methodological Quality ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Frozen Section ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Follicular Neoplasm ◽  
Summary Receiver Operating Characteristic

Abstract Objectives To evaluate the diagnostic performance of frozen section in thyroid nodules classified as follicular neoplasm. Methods A diagnostic test meta-analysis was designed. Studies that assessed frozen section in patients with thyroid nodules and a fine-needle aspiration biopsy result of Bethesda IV were selected. The outcomes measured were the number of false- and true-positive and -negative results. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) instrument for methodological quality assessment and a bivariate mixed-effects regression framework and a likelihood-based estimation of the exact binomial approach. Results Forty-six studies from 1991 to 2018 were included. Most studies had moderate methodological quality. The overall sensitivity and specificity were 43% (95% confidence internal [CI], 0.34-0.53) and 100% (95% CI, 0.99-1.00), respectively. The hierarchic summary receiver operating characteristic curve showed an area under the curve of 0.91 (95% CI, 0.80-0.97). Conclusions Frozen section demonstrates moderate diagnostic performance in patients with follicular neoplasm, and its utility for making intraoperative decisions is limited. Its routine use should be discouraged.

MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

2019 ◽  
Vol 61 (7) ◽  
pp. 964-972 ◽  
Author(s):  
Chong Hyun Suh ◽  
Seung Chai Jung ◽  
Se Jin Cho ◽  
Dong-Cheol Woo ◽  
Woo Yong Oh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Threshold Effect ◽  
Hemorrhagic Transformation ◽  
Summary Receiver Operating Characteristic ◽  
Mortality And Morbidity ◽  
Study Heterogeneity

Background Hemorrhagic transformation increases mortality and morbidity in patients with acute ischemic stroke. Purpose The purpose of this study is to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for prediction of hemorrhagic transformation in acute ischemic stroke. Material and Methods A systematic literature search of MEDLINE and EMBASE was performed up to 27 July 2018, including the search terms “acute ischemic stroke,” “hemorrhagic transformation,” and “MRI.” Studies evaluating the diagnostic performance of MRI for prediction of hemorrhagic transformation in acute ischemic stroke were included. Diagnostic meta-analysis was conducted with a bivariate random-effects model to calculate the pooled sensitivity and specificity. Subgroup analysis was performed including studies using advanced MRI techniques including perfusion-weighted imaging, diffusion-weighted imaging, and susceptibility-weighted imaging. Results Nine original articles with 665 patients were included. Hemorrhagic transformation is associated with high permeability, hypoperfusion, low apparent diffusion coefficient (ADC), and FLAIR hyperintensity. The pooled sensitivity was 82% (95% confidence interval [CI] 61–93) and the pooled specificity was 79% (95% CI 71–85). The area under the hierarchical summary receiver operating characteristic curve was 0.85 (95% CI 0.82–0.88). Although study heterogeneity was present in both sensitivity (I2=67.96%) and specificity (I2=78.93%), a threshold effect was confirmed. Studies using advanced MRI showed sensitivity of 92% (95% CI 70–98) and specificity of 78% (95% CI 65–87) to conventional MRI. Conclusion MRI may show moderate diagnostic performance for predicting hemorrhage in acute ischemic stroke although the clinical significance of this hemorrhage is somewhat uncertain.

scholarly journals Diagnostic Value of T-SPOT.TB Assay for Tuberculous Peritonitis: A Meta-Analysis

2020 ◽  
Vol 7 ◽  
Author(s):  
Ying Luo ◽  
Ying Xue ◽  
Liyan Mao ◽  
Qun Lin ◽  
Guoxing Tang ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Abdominal Tuberculosis ◽  
Tuberculous Peritonitis ◽  
Summary Receiver Operating Characteristic ◽  
Sensitivity Specificity

Background: Tuberculous peritonitis (TP) is a common form of abdominal tuberculosis (TB). Diagnosing TP remains challenging in clinical practice. The aim of the present meta-analysis was to evaluate the diagnostic accuracy of peripheral blood (PB) T-SPOT and peritoneal fluid (PF) T-SPOT for diagnosing TP.Methods: PubMed, EmBase, Cochrane, Scopus, Google scholar, China national knowledge internet, and Wan-Fang databases were searched for relevant articles from August 1, 2005 to July 5, 2020. Statistical analysis was performed using Stata, Revman, and Meta-Disc software. Diagnostic parameters including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic curve was used to determine the area under the curve (AUC).Results: Twelve studies were eligible and included in the meta-analysis. The analysis showed that the pooled sensitivity and specificity of PB T-SPOT in diagnosing TP were 0.91 (95% CI, 0.88–0.94) and 0.78 (95% CI, 0.73–0.81), respectively, while the pooled PLR, NLR, and DOR were 4.05 (95% CI, 2.73–6.01), 0.13 (95% CI, 0.07–0.23), and 37.8 (95% CI, 15.04–94.98), respectively. On the other hand, the summary estimates of sensitivity, specificity, PLR, NLR, and DOR of PF T-SPOT for TP diagnosis were 0.90 (95% CI, 0.85–0.94), 0.78 (95% CI, 0.72–0.83), 6.35 (95% CI, 2.67–15.07), 0.14 (95% CI, 0.09–0.21), and 58.22 (95% CI, 28.76–117.83), respectively. Furthermore, the AUC of PB T-SPOT and PF T-SPOT for TP diagnosis were 0.91 and 0.94, respectively.Conclusions: Our results indicate that both PB T-SPOT and PF T-SPOT can be served as sensitive approaches for the diagnosis of TP. However, the unsatisfactory specificities of these two methods limit their application as rule-in tests for TP diagnosis. Furthermore, the standardization of the operating procedure of PF T-SPOT is further needed.

scholarly journals Diagnostic performance of lung ultrasound for transient tachypnea of the newborn: A meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248827
Author(s):  
Lili He ◽  
Yinghua Sun ◽  
Wei Sheng ◽  
Qiong Yao
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
Large Scale ◽  
Lung Ultrasound ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Lower Sensitivity ◽  
Summary Receiver Operating Characteristic

Several recent studies demonstrated that lung ultrasound could achieve desired diagnostic accuracy for transient tachypnea of the neonate (TTN). However, the diagnostic performance of lung ultrasound for TTN has not been systematically studied to date. This meta-analysis aimed to investigate the performance of lung ultrasound in diagnosing TTN. The relevant literature was searched in PubMed, Medline, the Cochrane Library, and Embase databases without any restriction in terms of language and time until January 31, 2021. Studies that assessed the diagnostic performance of lung ultrasound for TTN were included. Seven studies with 1514 participants were summarized. The lung ultrasound provided more accurate performance for diagnosing TTN with pooled sensitivity and specificity of 0.67 [95% confidence interval (CI) = 0.63–0.71] and 0.97 (95% CI = 0.95–0.98), respectively. A higher summarized area under the summary receiver operating characteristic curve was observed as 0.9906. Lower sensitivity and area under the curve (AUC) of B-lines for TTN were observed as 0.330 (95% CI = 0.27–0.38) and 0.5000, respectively. Lung ultrasound provided highly accurate AUC, sensitivity, and specificity in detecting TTN. Large-scale studies are warranted in the future to confirm these results.

scholarly journals The meta-analysis for ideal cytokines to distinguish the latent and active TB infection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhenhong Wei ◽  
Yuanting Li ◽  
Chaojun Wei ◽  
Yonghong Li ◽  
Hui Xu ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Cochrane Library ◽  
World Population ◽  
Summary Receiver Operating Characteristic ◽  
Discriminative Ability ◽  
Cytokine Detection ◽  
Ifn Γ

Abstract Background One forth whole-world population is infected with Mycobacterium tuberculosis (Mtb), but 90% of them are asymptotic latent infection without any symptoms but positive result in IFN-γ release assay. There is lack of ideal strategy to distinguish active tuberculosis (TB) and latent tuberculosis infection (LTBI). Some scientist had focused on a set of cytokines as biomarkers besides interferon- gamma (IFN-γ) to distinguish active TB and LTBI, but with considerable variance of results. This meta-analysis aimed to evaluate the overall discriminative ability of potential immune molecules to distinguish active TB and LTBI. Methods PubMed, the Cochrane Library, and Web of Science databases were searched to identify studies assessing diagnostic roles of cytokines for distinguishing active TB and LTBI published up to August 2018. The quality of enrolled studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled diagnostic sensitivity and specificity of each cytokine was calculated by using Meta-DiSc software. Area under the summary receiver operating characteristic curve (AUC) was used to summarize the overall diagnostic performance of each biomarker. Results Fourteen studies with 982 subjects met the inclusion criteria, including 526 active TB and 456 LTBI patients. Pooled sensitivity, specificity and AUC for discriminating between active TB and LTBI were analyzed for IL-2 (0.87, 0.61 and 0.9093), IP-10 (0.77, 0.73 and 0.8609), IL-5 (0.64, 0.75 and 0.8533), IL-13 (0.75, 0.71 and 0.8491), IFN-γ (0.67, 0.75 and 0.8031), IL-10 (0.68, 0.74 and 0.7957) and TNF-α (0.67, 0.64 and 0.7783). The heterogeneous subgroup analysis showed that cytokine detection assays, TB incidence, and stimulator with Mtb antigens are main influence factors for their diagnostic performance. Conclusions The meta-analysis showed cytokine production could assist the distinction between active TB and LTBI, IL-2 with the highest overall accuracy. No single biomarker is likely to show sufficiently diagnostic performance due to limited sensitivity and specificity. Further prospective studies are needed to identify the optimal combination of biomarkers to enhanced diagnostic capacity in clinical practice.

scholarly journals The Diagnostic Performance of Afirma Gene Expression Classifier for the Indeterminate Thyroid Nodules: A Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Ying Liu ◽  
Bihui Pan ◽  
Li Xu ◽  
Da Fang ◽  
Xianghua Ma ◽  
...  
Keyword(s):  
Gene Expression ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Meta Analysis ◽  
High Sensitivity ◽  
Diagnostic Odds Ratio ◽  
Needle Aspiration ◽  
Summary Receiver Operating Characteristic ◽  
Gene Expression Classifier

Background. Approximately 15 to 30% of thyroid nodules evaluated by fine-needle aspiration (FNA) were classified as indeterminate; the accurate diagnostic molecular tests of these nodules remain a challenge. We aimed to evaluate the diagnostic performance of Afirma gene expression classifier (GEC) for the indeterminate thyroid nodules (ITNs). Methods. Studies published from January 2005 to December 2018 were systematically reviewed. The gold reference standard relied on the histopathologic results diagnosis from thyroidectomy surgical specimens. MetaDisc software was used to investigate the pooled sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves. Results. A total of 18 studies involving 5290 patients with 3290 cases of ITNs were included. Collected data revealed that the pooled sensitivity of GEC was 95.5% (95% CI 93.3%–97.0%, p < 0.001), the specificity was 22.1% (95% CI 19.4%-24.9%, p < 0.001), the NPV was 88.2% (95% CI 0.833–0.921, p < 0.001), the PPV was 44.3% (95% CI 0.416–0.471, p < 0.001), and the DOR was 5.25 (95% CI 3.42–8.04, p= 0.855). Conclusion. The GEC has quite high sensitivity of 95.5% but low specificity of 22.1%. The high sensitivity makes it probable to rule out malignant nodules. Thus, over half of nodules with GEC-suspicious results still require further validation like molecular markers, diagnostic surgery, or long follow-up, which limits its use in future clinical practice.

Diagnostic Accuracy of Noncontrast CT in Detecting Acute Appendicitis: A Meta-analysis of Prospective Studies

2015 ◽  
Vol 81 (6) ◽  
pp. 626-629 ◽  
Author(s):  
Bing Xiong ◽  
Baishu Zhong ◽  
Zhenwei Li ◽  
Feng Zhou ◽  
Ruying Hu ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Summary Receiver Operating Characteristic ◽  
Noncontrast Ct

The aim of the study is to evaluate the diagnostic accuracy of noncontrast CT in detecting acute appendicitis. Prospective studies in which noncontrast CT was performed to evaluate acute appendicitis were found on PubMed, EMBASE, and Cochrane Library. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were assessed. The summary receiver-operating characteristic curve was conducted and the area under the curve was calculated. Seven original studies investigating a total of 845 patients were included in this meta-analysis. The pooled sensitivity and specificity were 0.90 (95% CI: 0.86–0.92) and 0.94 (95% CI: 0.92–0.97), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio was 12.90 (95% CI: 4.80–34.67), 0.09 (95% CI: 0.04–0.20), and 162.76 (95% CI: 31.05–853.26), respectively. The summary receiver-operating characteristic curve was symmetrical and the area under the curve was 0.97 (95% CI: 0.95–0.99). In conclusion, noncontrast CT has high diagnostic accuracy in detecting acute appendicitis, which is adequate for clinical decision making.

scholarly journals Diagnostic Performance of the Magnetic Resonance Parkinsonism Index in Differentiating Progressive Supranuclear Palsy from Parkinson’s Disease: An Updated Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 12
Author(s):  
Seongken Kim ◽  
Chong Hyun Suh ◽  
Woo Hyun Shim ◽  
Sang Joon Kim
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Magnetic Resonance ◽  
Progressive Supranuclear Palsy ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Management Strategies ◽  
Area Under The Curve ◽  
Summary Receiver Operating Characteristic ◽  
Meta Regression

Progressive supranuclear palsy (PSP) and Parkinson’s disease (PD) are difficult to differentiate especially in the early stages. We aimed to investigate the diagnostic performance of the magnetic resonance parkinsonism index (MRPI) in differentiating PSP from PD. A systematic literature search of PubMed-MEDLINE and EMBASE was performed to identify original articles evaluating the diagnostic performance of the MRPI in differentiating PSP from PD published up to 20 February 2021. The pooled sensitivity, specificity, and 95% CI were calculated using the bivariate random-effects model. The area under the curve (AUC) was calculated using a hierarchical summary receiver operating characteristic (HSROC) model. Meta-regression was performed to explain the effects of heterogeneity. A total of 14 original articles involving 484 PSP patients and 1243 PD patients were included. In all studies, T1-weighted images were used to calculate the MRPI. Among the 14 studies, nine studies used 3D T1-weighted images. The pooled sensitivity and specificity for the diagnostic performance of the MRPI in differentiating PSP from PD were 96% (95% CI, 87–99%) and 98% (95% CI, 91–100%), respectively. The area under the HSROC curve was 0.99 (95% CI, 0.98–1.00). Heterogeneity was present (sensitivity: I2 = 97.29%; specificity: I2 = 98.82%). Meta-regression showed the association of the magnet field strength with heterogeneity. Studies using 3 T MRI showed significantly higher sensitivity (100%) and specificity (100%) than those of studies using 1.5 T MRI (sensitivity of 98% and specificity of 97%) (p < 0.01). Thus, the MRPI could accurately differentiate PSP from PD and support the implementation of appropriate management strategies for patients with PSP.

scholarly journals Serum CA72-4 as a biomarker in the diagnosis of colorectal cancer: A meta-analysis

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 164-171 ◽  
Author(s):  
Han Yanqing ◽  
Dong Cheng ◽  
Xu Ling
Keyword(s):  
Colorectal Cancer ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Negative Likelihood Ratio ◽  
Diagnostic Sensitivity ◽  
Published Data ◽  
Summary Receiver Operating Characteristic ◽  
True Negative

AbstractThe purpose of this meta-analysis was to investigate the serum CA72-4 as a biomarker in the diagnosis of colorectal cancer by pooling the open published data. Methods. An electronic search of databases Pubmed, Medline, Web of Science, Cochrane Embase CBM, and CNKI were performed by two reviewers (Han Yanqing, Dong Cheng) independently to identify the studies relevant to serum CA72-4 as a biomarker in the diagnosis of colorectal cancer. The patient number of true positive(tp), false positive(fp), false negative(fn) and true negative(tn) were extracted from each included study. The diagnostic performance of serum CA72-4 as a biomarker in the diagnosis of colorectal cancer was assessed by pooled sensitivity, specificity and hierarchical summary receiver operating characteristic curve (HSROC). All the data was pooled by MetaDiSc 1.4 and Stata/SE 11.0 statistical software. Results A total of 22 studies with 2474 colorectal patients and 1576 controls were included in the present study and meta-analysis. The combined diagnostic sensitivity and specificity were 0.50 (95%CI:0.48-0.52) and 0.86 (95%CI:0.84-0.88) for serum CA72-4 as a biomarker in the diagnosis of colorectal cancer. The pooled positive and negative likelihood ratio were 3.41(95%CI:2.57-4.53) and 0.62(0.55-0.71). The pooled area under the ROC curve (AUC) was 0.73. Deeks’funnel plot and Egger’s line regression test (p=0.49) showed no significant publication bias in the present meta-analysis. Conclusion Due toits low diagnostic sensitivity, the diagnostic performance of serum CA72-4 as a biomarker for colorectal cancer screening is limited.

scholarly journals Blood Procalcitonin Level as A Diagnostic Marker of Pediatric Bacterial Meningitis: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 846
Author(s):  
Heeyeon Kim ◽  
Yun-Ho Roh ◽  
Seo-Hee Yoon
Keyword(s):  
Bacterial Meningitis ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Odds Ratio ◽  
Summary Receiver Operating Characteristic ◽  
Mortality And Morbidity ◽  
Meningitis In Children ◽  
Sensitivity Specificity

Early diagnosis and treatment of bacterial meningitis in children are essential, due to the high mortality and morbidity rates. However, lumbar puncture is often difficult, and cerebrospinal fluid (CSF) culture takes time. This meta-analysis aims to determine the diagnostic accuracy of blood procalcitonin for detecting bacterial meningitis in children. We conducted a systematic search on electronic databases to identify relevant studies. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, and a hierarchical summary receiver operating characteristic curve and area under the curve (AUC) were determined. Eighteen studies with 1462 children were included in the analysis. The pooled sensitivity, specificity, and the DOR of blood procalcitonin for detecting bacterial meningitis were 0.87 (95% confidence interval (CI): 0.78–0.93); 0.85 (95% CI: 0.75–0.91), and 35.85 (95% CI: 10.68–120.28), respectively. The AUC for blood procalcitonin was 0.921. Blood procalcitonin also showed higher diagnostic accuracy for detecting bacterial meningitis than other conventional biomarkers, including serum C-reactive protein and leukocyte count, CSF leukocyte and neutrophil count, and CSF protein and glucose levels. Blood procalcitonin can be a good supplemental biomarker with high diagnostic accuracy in detecting bacterial meningitis in children.

The role of serum periostin in the diagnosis of asthma: A meta-analysis

2020 ◽  
Vol 41 (4) ◽  
pp. 240-247
Author(s):  
Lei Yang ◽  
Qingtao Zhao ◽  
Shuyu Wang
Keyword(s):  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Summary Receiver Operating Characteristic ◽  
True Negative ◽  
Negative Results ◽  
Noninvasive Biomarker ◽  
Sensitivity Specificity ◽  
Serum Periostin

Background: Serum periostin has been proposed as a noninvasive biomarker for asthma diagnosis and management. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. Methods: This meta-analysis aimed to evaluate the diagnostic accuracy of periostin level in the clinical determination of asthma. Several medical literature data bases were searched for relevant studies through December 1, 2019. The numbers of patients with true-positive, false-positive, false-negative, and true-negative results for the periostin level were extracted from each individual study. We assessed the risk of bias by using Quality Assessment of Diagnostic Accuracy Studies 2. We used the meta-analysis to produce summary estimates of accuracy. Results: In total, nine studies with 1757 subjects met the inclusion criteria. The pooled estimates of sensitivity, specificity, and diagnostic odds ratios for the detection of asthma were 0.58 (95% confidence interval [CI], 0.38‐0.76), 0.86 (95% CI, 0.74‐0.93), and 8.28 (95% CI, 3.67‐18.68), respectively. The area under the summary receiver operating characteristic curve was 0.82 (95% CI, 0.79‐0.85). And significant publication bias was found in this meta‐analysis (p = 0.39). Conclusion: Serum periostin may be used for the diagnosis of asthma, with moderate diagnostic accuracy.

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