Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests

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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Characteristics of patients who had a stroke not initially identified during emergency prehospital assessment: a systematic review

Emergency Medicine Journal ◽

10.1136/emermed-2020-209607 ◽

2021 ◽

pp. emermed-2020-209607

Author(s):

Stephanie P Jones ◽

Janet E Bray ◽

Josephine ME Gibson ◽

Graham McClelland ◽

Colette Miller ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

False Negative ◽

Visual Disturbance ◽

Screening Tools ◽

False Negatives ◽

Presenting Symptoms ◽

Ischaemic Attack ◽

Stroke Type ◽

Key Terms

BackgroundAround 25% of patients who had a stroke do not present with typical ‘face, arm, speech’ symptoms at onset, and are challenging for emergency medical services (EMS) to identify. The aim of this systematic review was to identify the characteristics of acute stroke presentations associated with inaccurate EMS identification (false negatives).MethodWe performed a systematic search of MEDLINE, EMBASE, CINAHL and PubMed from 1995 to August 2020 using key terms: stroke, EMS, paramedics, identification and assessment. Studies included: patients who had a stroke or patient records; ≥18 years; any stroke type; prehospital assessment undertaken by health professionals including paramedics or technicians; data reported on prehospital diagnostic accuracy and/or presenting symptoms. Data were extracted and study quality assessed by two researchers using the Quality Assessment of Diagnostic Accuracy Studies V.2 tool.ResultsOf 845 studies initially identified, 21 observational studies met the inclusion criteria. Of the 6934 stroke and Transient Ischaemic Attack patients included, there were 1774 (26%) false negative patients (range from 4 (2%) to 247 (52%)). Commonly documented symptoms in false negative cases were speech problems (n=107; 13%–28%), nausea/vomiting (n=94; 8%–38%), dizziness (n=86; 23%–27%), changes in mental status (n=51; 8%–25%) and visual disturbance/impairment (n=43; 13%–28%).ConclusionSpeech problems and posterior circulation symptoms were the most commonly documented symptoms among stroke presentations that were not correctly identified by EMS (false negatives). However, the addition of further symptoms to stroke screening tools requires valuation of subsequent sensitivity and specificity, training needs and possible overuse of high priority resources.

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027 Diagnostic Accuracy of a Single Serum Testosterone Measurement: The False Negative Rate

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2016.02.029 ◽

2016 ◽

Vol 13 (5) ◽

pp. S13

Author(s):

X. Ni ◽

D. Muram

Keyword(s):

Diagnostic Accuracy ◽

False Negative ◽

False Negative Rate ◽

Serum Testosterone ◽

Negative Rate

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Simple modifications of three routine in vitro tests of thyroid function.

Clinical Chemistry ◽

10.1093/clinchem/22.10.1715 ◽

1976 ◽

Vol 22 (10) ◽

pp. 1715-1718 ◽

Cited By ~ 1

Author(s):

R W Pain

Keyword(s):

Diagnostic Accuracy ◽

Thyroid Function ◽

False Positive ◽

Reference Range ◽

False Negative ◽

Work Load ◽

In Vitro Tests ◽

Free Thyroxine Index ◽

Total Thyroxine

Abstract Semi-automation of equipment and simple modifications of technique reduced the work load without loss of diagnostic accuracy for three commonly used in vitro tests of thyroid function (total thyroxine, thyrobinding index, and free thyroxine index). Major innovations were the use of serum standards for all tests and having each duplicate for tests performed by a different technician. Attention is drawn to the false-positive and false-negative errors that occur when the 95% euthyroid limits is the sole reference range used.

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Usefulness of Nasal Endoscopy for Diagnosing Patients With Chronic Rhinosinusitis: A Meta-Analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892419892157 ◽

2019 ◽

Vol 34 (2) ◽

pp. 306-314

Author(s):

Do Hyun Kim ◽

Youngjun Seo ◽

Kyung Min Kim ◽

Seoungmin Lee ◽

Se Hwan Hwang

Keyword(s):

Diagnostic Accuracy ◽

Chronic Rhinosinusitis ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Characteristic Curve ◽

False Negative ◽

Nasal Endoscopy ◽

Summary Receiver Operating Characteristic ◽

True Negative ◽

Endoscopic Score

Background We evaluated the accuracy of nasal endoscopy in diagnosing chronic rhinosinusitis (CRS) compared with paranasal sinus computed tomography (CT). Methods Two authors independently searched the 5 databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) up to March 2019. For all included studies, we calculated correlation coefficients between the endoscopic and CT scores. We extracted data on true-positive and false-positive and true-negative and false-negative results. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (version 2). Results We included 16 observational or retrospective studies. A high correlation ( r = .8543; 95% confidence interval [CI] [0.7685–0.9401], P < .0001, I2 = 76.58%) between endoscopy and CT in terms of the diagnostic accuracy for CRS was apparent. The odds ratio (Lund–Kennedy endoscopic score ≥1) was 7.915 (95% CI [4.435–14.124]; I2 = 28.361%). The area under the summary receiver operating characteristic curve was 0.765. The sensitivity and specificity were 0.726 (95% CI [0.584–0.834]) and 0.767 (95% CI [0.685–0.849]), respectively. However, high interstudy heterogeneity was evident given the different endoscopic score thresholds used (Lund–Kennedy endoscopic score ≥1 vs 2). In a subgroup analysis of studies using a Lund–Kennedy endoscopic score threshold ≥2, the area under the summary curve was 0.881, and the sensitivity and specificity were 0.874 (95% CI [0.783–0.930]) and 0.793 (95% CI [0.366–0.962]), respectively. Conclusion Nasal endoscopy is a useful diagnostic tool; the Lund–Kennedy score was comparable with that of CT.

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LO06: Role of the age adjusted D-dimer in suspected deep venous thrombosis

CJEM ◽

10.1017/cem.2017.68 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S29

Author(s):

P. Reardon ◽

S. Patrick ◽

M. Taljaard ◽

K. Thavorn ◽

M.A. Mukarram ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Older Patients ◽

Large Scale ◽

False Negative ◽

Cost Savings ◽

Low Risk ◽

Clinical Probability ◽

D Dimer

Introduction: It is well established that a negative D-dimer will reliably rule out thromboembolism in selected low risk patients. Multiple modified D-dimer cutoffs have been suggested for older patients to improve diagnostic specificity. However, these approaches are better established for pulmonary embolism than for deep venous thrombosis (DVT). This study will evaluate the diagnostic performance of previously suggested D-dimer cutoffs for low risk DVT patients in the ED, and assess for a novel cutoff with improved performance. Methods: This health records review included patients >50 years with suspected DVT who were low-risk and had a D-dimer performed. Our analysis evaluated the diagnostic accuracy of D-dimer cutoffs of 500 and the age adjusted (age x 10) rule for patients >50 years; and 750, and 1,000 cutoffs for patients >60 years. 30-day outcome was a diagnosis of DVT. We also assessed the diagnostic accuracy for a novel cutoff (age x 12.5). Results: 1,000 patients (mean age 68 years; 59% female) were included. Of these, 110 patients (11%) were diagnosed with DVT. The conventional cutoff of <500 µg/L demonstrated a sensitivity of 99.1% (95% CI 95.0-99.9) and a specificity of 36.4% (95% CI 33.2-39.7). For patients >60 years, the absolute cutoffs of 750 and 1,000 showed sensitivity of 98.7% (95% CI, 92.9, 99.9), and the specificity increased to 48.6% (95% CI, 44.5-52.8%) and 62.1% (95% CI, 58.1-66.1%) respectively. For all study patients, age adjusted D-dimer demonstrated a sensitivity of 99.1% (95% CI 95.0-99.9) and a specificity of 51.2% (95% CI, 47.9-54.6). A novel age adjusted cutoff (age x 12.5) for patients >50, demonstrated a sensitivity of 97.3% (95% CI 92.2-99.4) and a specificity of 61.2% (95% CI 58.0-64.5). When compared to conventional cutoff, the age adjusted cutoffs (age x 10 and age x 12.5) would have resulted in an absolute decrease in further investigations of 13.1% and 22.2%, respectively, with false negative rates of 0.1% and 0.3%. Conclusion: Among older patients with suspected DVT and low clinical probability, the age adjusted D-dimer increases the proportion of patients among whom DVT can be ruled out. A novel cutoff (age x 12.5) demonstrated improved specificity. Future large scale prospective studies are needed to confirm this finding and to explore the cost savings of these approaches.

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Noninvasive Electromagnetic Detection of Bladder Cancer

ISRN Urology ◽

10.1155/2014/802328 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Luigi Cormio ◽

Clarbruno Vedruccio ◽

Giorgio Leucci ◽

Paolo Massenio ◽

Giuseppe Di Fino ◽

...

Keyword(s):

Bladder Cancer ◽

Diagnostic Accuracy ◽

Predictive Value ◽

False Negative ◽

Electromagnetic Properties ◽

Urinary Cytology ◽

Predictive Values ◽

Electromagnetic Detection ◽

Voiding Symptoms ◽

Asymptomatic Patients

Objectives. Normal and neoplastic human tissues have different electromagnetic properties. This study aimed to determine the diagnostic accuracy of noninvasive electromagnetic detection of bladder cancer (BC) by the tissue-resonance interaction method (TRIM-prob). Patients and Methods. Consecutive patients were referred for cystoscopy because of (i) microscopic or gross hematuria and/or irritative voiding symptoms and (ii) bladder ultrasounds and urinary cytology findings negative or just suspicious of malignancy. Patients were first submitted to TRIM-prob bladder scanning by a single investigator and then to cystoscopy by another investigator blind to TRIM-prob data. Results. In 125 evaluated patients cystoscopy was positive for BC in 47 and negative in the remaining 78; conversely, TRIM-prob bladder scanning was positive for BC in 53 and negative in 72. In particular, TRIM-prob scanning yielded 7 false positives and only one false negative; therefore, its overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 97.9%, 89.9%, 86.8%, 98.6%, and 93.6%, respectively. Conclusions. TRIM-prob bladder scanning was a simple and quite accurate method for non-invasive electromagnetic detection of BC. If the elevated positive and negative predictive values will be replicated in further well-designed studies, it could be used to screen asymptomatic patients at high risk of BC.

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High Diagnostic Accuracy of Antigen Microarray for Sensitive Detection of Hepatitis C Virus Infection

Clinical Chemistry ◽

10.1373/clinchem.2007.090464 ◽

2008 ◽

Vol 54 (2) ◽

pp. 424-428 ◽

Cited By ~ 27

Author(s):

Jung-ah Kwon ◽

Hyeseon Lee ◽

Kap N o Lee ◽

Kwangchun Chae ◽

Seram Lee ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Detection Limit ◽

Diagnostic Accuracy ◽

False Positive ◽

Sol Gel ◽

False Negative ◽

Screening Method ◽

Confirmatory Test ◽

Specificity And Sensitivity

Abstract Background: Hepatitis C virus (HCV) can be transmitted through blood transfusion. Screening ELISA, the most widely used method for HCV diagnosis, sometimes yields false-positive and false-negative results, so a confirmatory test is used. This secondary testing is labor-intensive and expensive, and thus is impractical for massive blood bank screening. Therefore, a new massive screening method with high accuracy is needed for sensitive and specific detection of HCV. Methods: With sol-gel material, we designed novel antigen microarray in 96-well plates for HCV detection. Each individual well was spotted with 4 different HCV antigens. We used this new system to test 154 patient serum samples previously tested for HCV by ELISA (87 HCV positive and 67 HCV negative) (HCV EIA3.0, ABBOTT). We assessed the detection limit of our microarray system with the use of serial 10-fold dilutions of an HCV-positive sample. Results: Our microarray assay was reproducible and displayed higher diagnostic accuracy (specificity) (98.78%) than did the ELISA (81.71%). Our method yielded significantly fewer false-positive results than did the ELISA. The detection limit of our assay was 1000 times more sensitive than that of the ELISA. In addition, we found this novel assay technology to be compatible with the currently employed automated methods used for ELISA. Conclusion: We successfully applied the sol-gel–based protein microarray technology to a screening assay for HCV diagnosis with confirmatory test-level accuracy. This new, inexpensive method will improve the specificity and sensitivity of massive sample diagnosis.

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An assessment of the accuracy of contrast enema for the diagnosis of Hirschsprung disease at a South African tertiary hospital

South African Journal of Radiology ◽

10.4102/sajr.v21i1.1093 ◽

2017 ◽

Vol 21 (1) ◽

Author(s):

Monica S. Msomi ◽

Hansraj Mangray ◽

Vicci Du Plessis

Keyword(s):

Diagnostic Accuracy ◽

South African ◽

False Negative ◽

False Negative Rate ◽

Hirschsprung Disease ◽

Contrast Enema ◽

Initial Screening ◽

Tertiary Referral Hospital ◽

Predictive Values ◽

Picture Archiving And Communication

Objectives: To compare radiological findings with the histological diagnosis of Hirschsprung disease (HD) to establish the usefulness of contrast enema as an initial screening and diagnostic tool. To correlate accuracy of radiological diagnosis at Grey’s Hospital with international standards.Materials and methods: Systematic searches were conducted through the Picture Archiving and Communication System and the National Health Laboratory Service records for patients aged 0–12 years, with clinically suspected HD, for whom both contrast enemas and rectal biopsies were performed between 01 January 2011 and 31 August 2015 in a tertiary-level hospital. A total of 54 such patients were identified. Diagnostic accuracy levels were calculated by comparing radiological results with histology results, which is the gold standard.Results: Diagnostic accuracy of contrast enema was 78%, sensitivity was 94.4% and the negative predictive value was 95.7%. Specificity (68.8%) and positive predictive values (63%) were considerably lower. A lower false-negative rate of 5.6% was obtained at Grey’s Hospital as compared with the international reports of up to 30%.Conclusion: Contrast enema remains useful as an initial screening and diagnostic test for HD. Results of this South African tertiary referral hospital were consistent with the best international results for sensitivity of the contrast enema (approximately 80% – 88% in excluding the disease).

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Usefulness of composite methionine–positron emission tomography/3.0-tesla magnetic resonance imaging to detect the localization and extent of early-stage Cushing adenoma

Journal of Neurosurgery ◽

10.3171/2009.7.jns09285 ◽

2010 ◽

Vol 112 (4) ◽

pp. 750-755 ◽

Cited By ~ 31

Author(s):

Hidetoshi Ikeda ◽

Takehiko Abe ◽

Kazuo Watanabe

Keyword(s):

Mr Imaging ◽

Diagnostic Accuracy ◽

Fdg Pet ◽

Early Stage ◽

False Negative ◽

Mr Images ◽

Cushing Disease ◽

Significant Difference ◽

3.0 T ◽

Met Pet

Object Fifty to eighty percent of Cushing disease is diagnosed by typical endocrine responses. Recently, the number of diagnoses of Cushing disease without typical Cushing syndrome has been increasing; therefore, improving ways to determine the localization of the adenoma and making an early diagnosis is important. This study was undertaken to determine the present diagnostic accuracy for Cushing microadenoma and to compare the differences in diagnostic accuracy between MR imaging and PET/MR imaging. Methods During the past 3 years the authors analyzed the diagnostic accuracy in a series of 35 patients with Cushing adenoma that was verified by surgical pituitary exploration. All 35 cases of Cushing disease, including 20 cases of “overt” and 15 cases of “preclinical” Cushing disease, were studied. Superconductive MR images (1.5 or 3.0 T) and composite images from FDG-PET or methionine (MET)–PET and 3.0-T MR imaging were compared with the localization of adenomas verified by surgery. Results The diagnostic accuracy of superconductive MR imaging for detecting the localization of Cushing microadenoma was only 40%. The causes of unsatisfactory results for superconductive MR imaging were false-negative results (10 cases), false-positive results (6 cases), and instances of double pituitary adenomas (3 cases). In contrast, the accuracy of microadenoma localization using MET-PET/3.0-T MR imaging was 100% and that of FDG-PET/3.0-T MR imaging was 73%. Moreover, the adenoma location was better delineated on MET-PET/MR images than on FDG-PET/MR images. There was no significant difference in maximum standard uptake value of adenomas evaluated by MET-PET between preclinical Cushing disease and overt Cushing disease. Conclusions Composite MET-PET/3.0-T MR imaging is useful for the improvement of the delineation of Cushing microadenoma and offers high-quality detectability for early-stage Cushing adenoma.

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