Diagnostic performance and prognostic value of elastography in patients with biliary atresia and after hepatic portoenterostomy: protocol for a systematic review and meta-analysis

IntroductionBiliary atresia (BA) is a life-threatening disease with persistent neonatal cholestasis and progressive liver fibrosis. Timely non-invasive diagnosis of BA can result in early hepatic portoenterostomy (HPE) and better prognosis. Quantitative elastography enables the non-invasive measurement of liver stiffness. However, the studies on elastography methods in the diagnosis of BA and the prediction of post-HPE outcomes vary in their results and have small sample sizes. Thus, we propose this systematic review and meta-analysis to obtain comprehensive evidence on the value of elastography in BA.Methods and analysisWe will search the PubMed, Embase and the Cochrane Central Register of Controlled Trials databases for studies evaluating the diagnostic performance of elastography in patients with BA and the prognostic value of postoperative elastography, from inception to 31 December 2020. We plan to use the Quality Assessment of Diagnostic Accuracy Studies-2 list and the Quality In Prognosis Studies tool to assess the risk of bias in the included studies and the study quality. We will evaluate the diagnostic performance of elastography by synthesising the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic OR and summary receiver operating characteristic curve using Meta-Disc V.1.4. We will evaluate the predictive value of elastography after HPE by synthesising the pooled correlation coefficient and pooled OR of prognostic outcomes using STATA V.14. The funnel plot and Egger’s test will be used to evaluate the potential publication bias. Sensitivity analysis will be conducted by examining the estimated effects of individual studies.Ethics and disseminationAs this study is a meta-analysis based on previously published literature, ethical approval is not necessary according to the ethics committee of West China Hospital, Sichuan University. The results of this study will be published in a peer-reviewed journal.PROSPERO registration numberCRD42020162055.

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DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-16-0297 ◽

2016 ◽

Vol 175 (2) ◽

pp. R65-R80 ◽

Cited By ~ 40

Author(s):

Irina Bancos ◽

Shrikant Tamhane ◽

Muhammad Shah ◽

Danae A Delivanis ◽

Fares Alahdab ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Performance ◽

Small Sample Size ◽

Controlled Trial ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Central Register ◽

Moderate Risk ◽

Adrenal Biopsy ◽

Adrenocortical Carcinomas

ObjectiveTo perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.MethodsMedline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.ResultsWe included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6–11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5–3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.ConclusionsEvidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

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The Prognostic Value of Toll-Like Receptors in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

International Journal of Molecular Sciences ◽

10.3390/ijms21197255 ◽

2020 ◽

Vol 21 (19) ◽

pp. 7255

Author(s):

Shrabon Hasnat ◽

Roosa Hujanen ◽

Bright I. Nwaru ◽

Tuula Salo ◽

Abdelhakim Salem

Keyword(s):

Systematic Review ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Prognostic Value ◽

Meta Analysis ◽

Small Sample ◽

Neck Squamous Cell Carcinoma ◽

Toll Like Receptors

Head and neck squamous cell carcinoma (HNSCC) is a group of tumours which exhibit low 5 year survival rates. Thus, there is an urgent need to identify biomarkers that may improve the clinical utility of patients with HNSCC. Emerging studies support a role of toll-like receptors (TLRs) in carcinogenesis. Therefore, this systematic review and meta-analysis was performed to assess the prognostic value of TLR immunoexpression in HNSCC patients. We compiled the results of thirteen studies comprising 1825 patients, of which six studies were deemed qualified for quantitative synthesis. The higher immunoexpression of TLR-1 to 5 and 9 was associated with a worsening of the clinical parameters of patients with HNSCC. Furthermore, induced levels of TLR-3, 4, 5, 7 and 9 were found to predict the patients’ survival time. The meta-analysis revealed that TLR-7 overexpression is associated with a decreased mortality risk in HNSCC patients (HR 0.51; 95%CI 0.13–0.89; I2 34.6%), while a higher expression of TLR-5 predicted shorter, but non-significant, survival outcome. In conclusion, this review suggests that TLRs may represent some prognostic value for patients with HNSCC. However, due to small sample sizes and other inherent methodological limitations, more well designed studies across different populations are still needed before TLRs can be recommended as a reliable clinical risk-stratification tool.

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Adherence to Teriparatide Treatment and Risk of Fracture: A Systematic Review and Meta-Analysis

Hormone and Metabolic Research ◽

10.1055/a-1062-9447 ◽

2019 ◽

Vol 51 (12) ◽

pp. 785-791 ◽

Cited By ~ 1

Author(s):

Qing Chen ◽

Man Guo ◽

Xiumei Ma ◽

Yueli Pu ◽

Yang Long ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Treatment Adherence ◽

North American ◽

Meta Analysis ◽

Small Sample ◽

Treatment Result ◽

Cochrane Central Register ◽

Risk Of Fracture ◽

Teriparatide Treatment

AbstractTo conduct a retrospective systematic review and meta-analysis of studies investigating the fracture risk among adherence versus non-adherence patients to treatment for osteoporosis. Cohort studies involving adherence to specifically Teriparatide treatment and the risk of fracture, published from inception to June 10 2019, were identified through PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus database of Systematic Reviews. Five eligible cohort studies were included for analysis. Overall, adherence, compared with nonadherence, had a significant 28% reduction in the risk of all fractures, an 49% reduction in the risk of hip fracture and an 26% reduction in the risk of non-vertebral fracture. Subgroup analyses showed that treatment compliant North American patients had a lower incidence of fracture than treatment compliant Asian patients. The effect size associated with adherence showed no difference with non-adherence when the analysis was limited to a small sample size (<10 000 patients). The findings of this retrospective review indicate that high compliance of Teriparatide treatment result in a decreased risk of fracture, particularly in North American treatment adherence, compared with Asian treatment adherence. Improvement of treatment adherence in patients with osteoporosis should be considered through various means in clinical practice.

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Prognostic value of Red Blood Cell Distribution Width in Acute Kidney Injury Patients: A Systematic Review and Meta-analysis

10.1101/750190 ◽

2019 ◽

Author(s):

Zhengsheng Liu ◽

Shanshan Wang ◽

Xiongbo Yao ◽

Jinchun Xing

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Prognostic Value ◽

Meta Analysis ◽

Kidney Injury ◽

Small Sample ◽

Significant Heterogeneity ◽

Cell Distribution ◽

Distribution Width ◽

Conflicting Result

AbstractBackgroundThe conflicting result with regard to Red Cell Distribution Width (RDW) with Acute Kidney Injury (AKI) has been reported. This systematic review and meta-analysis were aimed to investigate RDW and prognostic value in AKI patients.Methods/Main ResultsThis meta-analysis included 1251 cases and 1663 controls with a total of 7 enrolled published papers. The results of RDW levels were significantly associated with patients of AKI (WMD=1.127, 95% CI=0.426-1.827; P=0.002), with statistically significant heterogeneity (I2 =95.80%, Pheterogeneity =0.000, random-effects model).ConclusionsIn conclusion, the results of this present meta-analysis suggest that the RDW value is a positive prognostic indicator in patients with AKI. However, these results were obtained on the basis of RCS or small sample sizes studies. Further functional studies with additional data would be needed to validate our findings.

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Comparative Analysis of Diagnostic Techniques for Melanoma Detection: A Systematic Review of Diagnostic Test Accuracy Studies and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.637069 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alessia Blundo ◽

Arianna Cignoni ◽

Tommaso Banfi ◽

Gastone Ciuti

Keyword(s):

Systematic Review ◽

Diagnostic Performance ◽

Meta Analysis ◽

Diagnostic Techniques ◽

Test Accuracy ◽

Diagnostic Reliability ◽

Non Invasive ◽

Melanoma Detection ◽

Melanoma Diagnosis ◽

Dta Studies

Melanoma has the highest mortality rate among skin cancers, and early-diagnosis is essential to maximize survival rate. The current procedure for melanoma diagnosis is based on dermoscopy, i.e., a qualitative visual inspection of lesions with intrinsic limited diagnostic reliability and reproducibility. Other non-invasive diagnostic techniques may represent valuable solutions to retrieve additional objective information of a lesion. This review aims to compare the diagnostic performance of non-invasive techniques, alternative to dermoscopy, for melanoma detection in clinical settings. A systematic review of the available literature was performed using PubMed, Scopus and Google scholar databases (2010-September 2020). All human, in-vivo, non-invasive studies using techniques, alternative to dermoscopy, for melanoma diagnosis were included with no restriction on the recruited population. The reference standard was histology but dermoscopy was accepted only in case of benign lesions. Attributes of the analyzed studies were compared, and the quality was evaluated using CASP Checklist. For studies in which the investigated technique was implemented as a diagnostic tool (DTA studies), the QUADAS-2 tool was applied. For DTA studies that implemented a melanoma vs. other skin lesions classification task, a meta-analysis was performed reporting the SROC curves. Sixty-two references were included in the review, of which thirty-eight were analyzed using QUADAS-2. Study designs were: clinical trials (13), retrospective studies (10), prospective studies (8), pilot studies (10), multitiered study (1); the remain studies were proof of concept or had undefined study type. Studies were divided in categories based on the physical principle employed by each diagnostic technique. Twenty-nine out of thirty-eight DTA studies were included in the meta-analysis. Heterogeneity of studies' types, testing strategy, and diagnostic task limited the systematic comparison of the techniques. Based on the SROC curves, spectroscopy achieved the best performance in terms of sensitivity (93%, 95% CI 92.8–93.2%) and specificity (85.2%, 95%CI 84.9–85.5%), even though there was high concern regarding robustness of metrics. Reflectance-confocal-microscopy, instead, demonstrated higher robustness and a good diagnostic performance (sensitivity 88.2%, 80.3–93.1%; specificity 65.2%, 55–74.2%). Best practice recommendations were proposed to reduce bias in future DTA studies. Particular attention should be dedicated to widen the use of alternative techniques to conventional dermoscopy.

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Diagnostic Performance of Sonographic Features in Patients With Biliary Atresia: A Systematic Review and Meta-analysis

Journal of Ultrasound in Medicine ◽

10.1002/jum.14234 ◽

2017 ◽

Vol 36 (10) ◽

pp. 2027-2038 ◽

Cited By ~ 5

Author(s):

Hee Mang Yoon ◽

Chong Hyun Suh ◽

Jeong Rye Kim ◽

Jin Seong Lee ◽

Ah Young Jung ◽

...

Keyword(s):

Systematic Review ◽

Biliary Atresia ◽

Diagnostic Performance ◽

Meta Analysis

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The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis

CJEM ◽

10.1017/cem.2018.498 ◽

2019 ◽

Vol 21 (3) ◽

pp. 406-417 ◽

Cited By ~ 7

Author(s):

Sean P. Stickles ◽

Christopher R. Carpenter ◽

Robert Gekle ◽

Chadd K. Kraus ◽

Caryn Scoville ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Point Of Care ◽

Meta Analysis ◽

Hypovolemic Shock ◽

Point Of Care Ultrasound ◽

Cochrane Central Register ◽

Study Quality ◽

Obstructive Shock

ABSTRACTObjectiveThe aim of this study was to perform a systematic review and meta-analysis of the diagnostic accuracy of a point-of-care ultrasound exam for undifferentiated shock in patients presenting to the emergency department.MethodsOvid MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and research meeting abstracts were searched from 1966 to June 2018 for relevant studies. QUADAS-2 was used to assess study quality, and meta-analysis was conducted to pool performance data of individual categories of shock.ResultsA total of 5,097 non-duplicated studies were identified, of which 58 underwent full-text review; 4 were included for analysis. Study quality by QUADAS-2 was considered overall a low risk of bias. Pooled positive likelihood ratio values ranged from 8.25 (95% CI 3.29 to 20.69) for hypovolemic shock to 40.54 (95% CI 12.06 to 136.28) for obstructive shock. Pooled negative likelihood ratio values ranged from 0.13 (95% CI 0.04 to 0.48) for obstructive shock to 0.32 (95% CI 0.16 to 0.62) for mixed-etiology shock.ConclusionThe rapid ultrasound for shock and hypotension (RUSH) exam performs better when used to rule in causes of shock, rather than to definitively exclude specific etiologies. The negative likelihood ratios of the exam by subtype suggest that it most accurately rules out obstructive shock.

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