Evaluation of Xpert MTB/RIF for the Diagnosis of Lymphatic Tuberculosis

Background. The World Health Organization approved the use of Xpert MTB/RIF for the detection of Mycobacterium tuberculosis DNA, which has significantly improved the diagnosis of tuberculosis. In this study, our main objective was to evaluate the diagnostic efficacy of Xpert MTB/RIF for lymphoid tuberculosis to determine whether Xpert MTB/RIF could be used as a routine detection method. Materials and Methods. We searched four databases for the relevant literature published from May 2007 to December 2019. The quality of the literature was evaluated with reference to the evaluation criteria. Data that were extracted from the literature on Xpert MTB/RIF diagnosis of lymphatic tuberculosis were used to plot the summary receiver operating characteristic (SROC) curve, after which the software was used to combine and analyze the accuracy of these data. Results. A total of 27 studies were included. The sensitivity of Xpert MTB/RIF for detecting lymphatic tuberculosis was 0.79 (95% CI (0.77, 0.81)), the specificity was 0.88 (95% CI (0.87, 0.90)), and the positive likelihood ratio (PLR) was 7.21 (95% CI (4.93, 10.55)). In addition, the negative likelihood ratio (NLR) was 0.25 (95% CI (0.19, 0.32)) and the diagnostic odds ratio (DOR) was 40.23 (95% CI (24.53, 65.98)). At the same time, we used the extracted data to make the SROC curve, obtaining the following parameters: area under the curve AUC=0.9144, Q=0.8470 (SE=0.0163). Conclusion. Xpert MTB/RIF has high accuracy in detecting lymphatic tuberculosis, and it can be used to quickly and easily diagnose lymphatic tuberculosis at an early stage as a general method.

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Artificial Intelligence in Gastric Cancer: Identifying Gastric Cancer Using Endoscopic Images with Convolutional Neural Network

Cancers ◽

10.3390/cancers13215253 ◽

2021 ◽

Vol 13 (21) ◽

pp. 5253

Author(s):

Md. Mohaimenul Islam ◽

Tahmina Nasrin Poly ◽

Bruno Andreas Walther ◽

Ming-Chin Lin ◽

Yu-Chuan (Jack) Li

Keyword(s):

Gastric Cancer ◽

Likelihood Ratio ◽

Meta Analysis ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Work Load ◽

Diagnostic Odds Ratio ◽

Summary Receiver Operating Characteristic ◽

Sensitivity Specificity

Gastric cancer (GC) is one of the most newly diagnosed cancers and the fifth leading cause of death globally. Identification of early gastric cancer (EGC) can ensure quick treatment and reduce significant mortality. Therefore, we aimed to conduct a systematic review with a meta-analysis of current literature to evaluate the performance of the CNN model in detecting EGC. We conducted a systematic search in the online databases (e.g., PubMed, Embase, and Web of Science) for all relevant original studies on the subject of CNN in EGC published between January 1, 2010, and March 26, 2021. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the risk of bias. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. Moreover, a summary receiver operating characteristic curve (SROC) was plotted. Of the 171 studies retrieved, 15 studies met inclusion criteria. The application of the CNN model in the diagnosis of EGC achieved a SROC of 0.95, with corresponding sensitivity of 0.89 (0.88–0.89), and specificity of 0.89 (0.89–0.90). Pooled sensitivity and specificity for experts endoscopists were 0.77 (0.76–0.78), and 0.92 (0.91–0.93), respectively. However, the overall SROC for the CNN model and expert endoscopists was 0.95 and 0.90. The findings of this comprehensive study show that CNN model exhibited comparable performance to endoscopists in the diagnosis of EGC using digital endoscopy images. Given its scalability, the CNN model could enhance the performance of endoscopists to correctly stratify EGC patients and reduce work load.

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The Accuracy of Single MicroRNAs in Peripheral Blood to Diagnose Ovarian Cancer: An Updated Meta-Analysis

Disease Markers ◽

10.1155/2020/1075942 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Yubao Cui ◽

Shanchao Hong ◽

Xuming Zhu

Keyword(s):

Ovarian Cancer ◽

Likelihood Ratio ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

The United States ◽

Diagnostic Odds Ratio ◽

Diagnostic Value ◽

Summary Receiver Operating Characteristic ◽

Carbohydrate Antigen 125

Background. Ovarian cancer is the 5th leading cause of death of women due to cancer in the United States. Although carbohydrate antigen 125 has a moderate diagnostic utility, the phenomenon of false-positive exists. As novel effective biomarkers, some single microRNAs (miRNAs) have diagnostic values for ovarian cancer, but the results lack consistency. In order to precisely and comprehensively assess the diagnostic value of single miRNAs for ovarian cancer, a meta-analysis is performed. Methods. Articles concerning the diagnostic value of single miRNAs for ovarian cancer were searched from databases. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with the corresponding 95% confidence interval (CI) were calculated. Area under curve (AUC) of the summary receiver-operating characteristic (SROC) curve was also calculated. Results. In total, 22 studies including 8 kinds of single miRNAs were enrolled in this paper (6 studies for miR-200c, 3 studies for miR-200a and miR-200b, and 2 studies for miR-205, miR-145, miR-141, miR-429, and miR-125b). For miR-200c, the pooled SEN and SPE were, respectively, 0.768 (95% CI: 0.722-0.811) and 0.680 (95% CI: 0.624-0.732); the pooled PLR and NLR were, respectively, 2.897 (95% CI: 1.787-4.698) and 0.340 (95% CI: 0.276-0.417); the pooled DOR was 8.917 (95% CI: 4.521-17.587); and AUC of SROC curve was 0.815. For miR-200a, the pooled SEN and SPE were, respectively, 0.759 (95% CI: 0.670-0.833) and 0.717 (95% CI: 0.627-0.795); the pooled PLR and NLR were, respectively, 3.129 (95% CI: 0.997-9.816) and 0.301 (95% CI: 0.207-0.437); the pooled DOR was 11.323 (95% CI: 3.493-36.711); and AUC of SROC curve was 0.857. For miR-200b, the pooled SEN and SPE were, respectively, 0.853 (95% CI: 0.776-0.912) and 0.775 (95% CI: 0.690-0.846); the pooled PLR and NLR were, respectively, 4.327 (95% CI: 0.683-27.415) and 0.225 (95% CI: 0.081-0.625); the pooled DOR was 19.678 (95% CI: 2.812-137.72); and AUC of SROC curve was 0.90. For miR-205, miR-145, miR-141, miR-429, and miR-125b, each diagnostic value should be interpreted cautiously because only two studies were included. Conclusions. miR-200c, miR-200a, and miR-200b can be useful diagnostic biomarkers for ovarian cancer. More related studies are needed for miR-205, miR-145, miR-141, miR-429, and miR-125b.

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Circulating tumor DNA RASSF1 methylation for predicting cancer risk: a diagnostic meta-analysis

Future Oncology ◽

10.2217/fon-2019-0219 ◽

2019 ◽

Vol 15 (30) ◽

pp. 3513-3525

Author(s):

Xin Sun ◽

Hao Li ◽

Mingjun Sun ◽

Yuan Yuan ◽

Liping Sun

Keyword(s):

Likelihood Ratio ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Circulating Tumor Dna ◽

China National Knowledge Infrastructure ◽

Summary Receiver Operating Characteristic ◽

Potential Biomarker ◽

Tumor Dna

Aim: We conducted a meta-analysis to assess diagnostic accuracy of circulating tumor DNA RASSF1 methylation in cancer. Materials & methods: Studies were searched from PubMed, Embase, Web of Science and China National Knowledge Infrastructure databases for articles published until December 2018. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic were used to assess the diagnostic value, and MethHC database was used for verification. Results: 13 studies with 1237 subjects and 676 cancer patients were enrolled. The area under curve was 0.80 (95% CI: 0.76–0.83), the pooled sensitivity was 0.35 (95% CI: 0.31–0.39) and the specificity was 0.97 (95% CI: 0.95–0.98). Verification by MethHC database was almost consistent with the result of meta-analysis. Conclusion: Circulating tumor DNA RASSF1 methylation is a potential biomarker for predicting cancer.

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Evaluation of the Diagnostic Efficacy of Xpert CT/NG for Chlamydia trachomatis and Neisseria gonorrhoeae

BioMed Research International ◽

10.1155/2020/2892734 ◽

2020 ◽

Vol 2020 ◽

pp. 1-16

Author(s):

Tian-Ao Xie ◽

Ye-Ling Liu ◽

Rui-Chun Meng ◽

Xiao-Shan Liu ◽

Ke-Ying Fang ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Likelihood Ratio ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Cochrane Library ◽

Summary Receiver Operating Characteristic ◽

Diagnostic Efficacy

Background. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widely spread across the world. Asymptomatic or inconspicuous CT/NG infections are difficult to diagnose and treat. Traditional methods have the disadvantages of low detection rate, inaccurate results, and long detection time. However, Xpert CT/NG makes up for the aforementioned shortcomings and has research value and popularization significance. Methods. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched, and studies were screened using Xpert CT/NG for diagnosing CT/NG. QUADAS-2 was used to evaluate the quality of the eligible studies. Then, two groups of researchers independently extracted data from these studies. Meta-analyses of sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve were conducted using Meta-DiSc 1.4. Finally, Deek’s funnel plots were made using Stata 12.0 to evaluate publication bias. Results. 14 studies were identified, and 46 fourfold tables were extracted in this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR, and AUC in diagnosing CT were 0.94 (95% confidence interval (CI): 0.93–0.95), 0.99 (95% CI: 0.99–1.00), 97.17 (95% CI: 56.76–166.32), 0.07 (95% CI: 0.04–0.12), 1857.25 (95% CI: 943.78–3654.86), and 0.9960, respectively. The pooled SEN, SPE, PLR, NLR, DOR, and AUC in diagnosing NG were 0.95 (95% CI: 0.93–0.96), 1.00 (95% CI: 1.00–1.00), 278.15 (95% CI: 152.41–507.63), 0.08 (95% CI: 0.06–0.12), 4290.70 (95% CI: 2161.78–8516.16), and 0.9980, respectively. Conclusions. Xpert CT/NG had high diagnostic sensitivity and specificity for CT and NG. However, more evidence is required to confirm that Xpert CT/NG might serve as the primary method for detecting CT and NG and even the gold standard for diagnosis in the future.

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Meta-Analysis of microRNAs as Potential Biomarkers for Detecting Esophageal Carcinoma in Asian Populations

The International Journal of Biological Markers ◽

10.5301/ijbm.5000296 ◽

2017 ◽

Vol 32 (4) ◽

pp. 375-383 ◽

Cited By ~ 1

Author(s):

Mei Li ◽

Fei Wu ◽

Yu Ji ◽

Lan Yang ◽

Feng Li

Keyword(s):

Esophageal Carcinoma ◽

Likelihood Ratio ◽

Meta Analysis ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Healthy Controls ◽

Summary Receiver Operating Characteristic ◽

Significant Difference

Background An Increasing number of studies in the literature have shown that microRNAs (miRNAs) can be used as early diagnostic markers for esophageal carcinoma (EC), but their conclusions remain controversial. Hence, we performed this meta-analysis to evaluate the diagnostic accuracy of using miRNAs in EC and to provide an experimental basis for early diagnosis of the disease. Methods This meta-analysis included 39 Asian studies from 18 articles, which covered 3,708 EC patients and 2,689 healthy controls. We used a bivariate random-effects model, the chi-square test and the I2 test to assess sensitivity and heterogeneity. Results Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of miRNAs for diagnosis of EC in Asians reached 0.798, 0.785, 3.705, 0.257 and 14.391, respectively. Additionally, the area under the summary receiver operating characteristic curve was 0.86. Subgroup analysis based on research country (China vs. Japan), sample types (plasma vs. serum) and miRNAs (single vs. multiple; singly reported miRNAs vs. repeatedly reported miRNAs) showed no significant difference in accuracy of diagnosis for each subgroup. Conclusions MiRNAs can distinguish EC patients from healthy controls. Blood-based miRNAs have better diagnostic value in detecting EC than saliva-based miRNAs, whereas both serum and plasma are recommended for clinical specimens for miRNA detection.

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Vasculogenic mimicry as a poor diagnostic and prognostic indicator in patients with malignant‎ melanoma: A ‎systematic review and meta-analysis

10.21203/rs.2.11912/v1 ◽

2019 ◽

Author(s):

Zhenhua Zhang ◽

Saber Imani ◽

Marzieh Dehghan Shasaltaneh ◽

Hossein Hosseinifard ◽

Zou Linglin ◽

...

Keyword(s):

Systematic Review ◽

Likelihood Ratio ◽

Meta Analysis ◽

Vasculogenic Mimicry ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Prognostic Indicator ◽

Diagnostic Odds Ratio ◽

P Value ◽

Summary Receiver Operating Characteristic

Abstract Background Vasculogenic mimicry (VM), a brand-new tumor microvascular model of non-endothelial cells, is proposed as an important therapeutic target in malignant melanoma (MM). We performed a systematic review to evaluate the diagnostic and prognostics accuracy of VM for overall survival of MM patients. Methods The quality of the included studies was assessed by QUADAS-2 tool. Diagnostic capacity of VM variables were pooled by the Meta-Disc software in term of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC). Results A retrospective observational study was conducted based on ‎ten studies including 978 clinically melanoma patients with proportion (P). VM+ melanoma cells are associated with poor prognosis in 38% of MM group (P = 0.35, 95% confidence intervals (CI): 0.27-0.42, P-value < 0.001). The pooled sensitivity and specificity were 0.82 (95% CI: 0.79-0.84) and 0.69 (95% CI: 0.66-0.71), respectively. Furthermore, the pooled PLR, NLR, and DOR were 2.56 (95% CI: 1.94-3.93), 0.17 (95% CI: 0.07-0.42), and 17.75 (95% CI: 5.30-59.44), respectively. Also, the AUC of SROC was 0.63, indicating the highly conserving of VM as a biomarker‎. Importantly, subgroup results suggested that VM+ tumor was significantly accurate prognostics biomarkers when diagnosed by CD31-/PAS+ staining methods in Asian MM samples (P-value > 0.001). Conclusions Our finding supports the VM+ tumor as a promising prognostic biomarker and effective adjuvant therapeutic strategy in prognostics of Asian MM patients.

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Accumulate evidence for IP-10 in diagnosing pulmonary tuberculosis

10.21203/rs.2.11284/v1 ◽

2019 ◽

Author(s):

Xia Qiu ◽

Tao Xiong ◽

Xiaojuan Su ◽

Yi Qu ◽

Long Ge ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Likelihood Ratio ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Assay Method ◽

Cochrane Library ◽

Summary Receiver Operating Characteristic ◽

Sensitivity Specificity

Abstract Backgrounds Pulmonary tuberculosis (PTB) is a major health and economic burden. Accurate PTB detection is an important step to eliminating TB globally. Interferon gamma-induced protein 10 (IP-10) has been reported as a potential diagnostic marker for PTB since 2007. In this study, a meta-analysis approach was used to assess diagnostic value of IP-10 for PTB. Methods Web of Science, PubMed, the Cochrane Library, and Embase databases were searched for studies published in English up to February 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and hierarchical summary receiver operating characteristic (HSROC) curve were estimated by a HSROC model. Results Eighteen studies including 2836 total participants met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of IP-10 for PTB detection were 86%, 88%, 7.00, and 0.16, respectively. The pooled DOR was 43.01, indicating a very powerful discriminatory ability of IP-10. Meta-regression showed that there was no heterogeneity with respect to TB burden, study design type, age, IP-10 assay method, IP-10 condition and HIV-infection status. Conclusions Our results showed that IP-10 is a promising marker for differentiating PTB from non-TB.

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The role of vascular mimicry as a biomarker in malignant melanoma: a systematic review and meta-analysis

BMC Cancer ◽

10.1186/s12885-019-6350-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Zhenhua Zhang ◽

Saber Imani ◽

Marzieh Dehghan Shasaltaneh ◽

Hossein Hosseinifard ◽

Linglin Zou ◽

...

Keyword(s):

Malignant Melanoma ◽

Likelihood Ratio ◽

Prognostic Biomarker ◽

High Reliability ◽

Meta Analysis ◽

Vasculogenic Mimicry ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Summary Receiver Operating Characteristic

Abstract Background Vasculogenic mimicry (VM) a microvascular system consisting of non-endothelial cells that is newly formed by aggressive tumors, has been proposed as an important therapeutic target in malignant melanoma (MM). We performed a systematic literature review to evaluate the diagnostic and prognostic accuracy of VM status for overall survival of MM patients. Methods The quality of the included studies was evaluated using the QUADAS-2 tool. Diagnostic capacity of VM variables, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under summary receiver operating characteristic (SROC), were pooled using Meta-DiSc software. Results A retrospective observational study was conducted based on twelve clinical studies including 978 clinically confirmed melanoma patients with proportion (P). VM+ melanoma cells were associated with poor prognosis in 38% of MM group (P = 0.35, 95% confidence intervals (CI): 0.27–0.42, p < 0.001). The pooled sensitivity and specificity were 0.82 (95% CI: 0.79–0.84) and 0.69 (95% CI: 0.66–0.71), respectively. Furthermore, the pooled PLR, NLR, and DOR were 2.56 (95% CI: 1.94–3.93), 0.17 (95% CI: 0.07–0.42), and 17.75 (95% CI: 5.30–59.44), respectively. Furthermore, the AUC of SROC was 0.63, indicating high reliability of VM status as a biomarker. Importantly, subgroup results suggested that VM+ status is a significantly accurate prognostic biomarker when diagnosed by the CD31−/PAS+ staining methods in Asian MM samples (p < 0.001). Conclusions Our findings support the potential of VM status of tumors as a promising prognostic biomarker and emphasize an effective adjuvant therapeutic strategy in the prognosis of Asian MM patients.

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Urinary Angiogenin as a Marker for Bladder Cancer: A Meta-Analysis

BioMed Research International ◽

10.1155/2021/5557309 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Amir Hossein Aalami ◽

Hossein Abdeahad ◽

Mohammad Mesgari ◽

Thozhukat Sathyapalan ◽

Amirhossein Sahebkar

Keyword(s):

Bladder Cancer ◽

Likelihood Ratio ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Case Control Studies ◽

Summary Receiver Operating Characteristic

Aims. Bladder cancer (BCa) is a common cancer in North America and Europe that carries considerable morbidity and mortality. A reliable biomarker for early detection of the bladder is crucial for improving the prognosis of BCA. In this meta-analysis, we examine the diagnostic role of the angiogenin (ANG) protein in patients’ urine with bladder neoplasm. Methods. We performed a systematic literature search using ScienceDirect, Web of Science, PubMed/MEDLINE, Scopus, Google Scholar, and Embase, up to 10th October 2020 databases. Meta-Disc V.1.4 and Comprehensive Meta-Analysis V.2.2 software calculated the pooled specificity, sensitivity, area under the curve (AUC), diagnostic odds ratio (DOR), positive likelihood ratio (LR+), negative likelihood ratio (LR-), Q ∗ index, and summary receiver-operating characteristic (SROC) for the role of ANG as a urinary biomarker for BCa patients. Results. Four case-control studies were included with 656 participants (417 cases and 239 controls) in this meta-analysis. The pooled sensitivity of 0.71 (95% CI: 0.66–0.75), specificity of 0.78 (95% CI: 0.73–0.81), LR+ of 3.34 (95% CI: 2.02–5.53), LR- of 0.37 (95% CI: 0.32–0.44), DOR of 9.99 (95% CI: 4.69–21.28), and AUC of 0.789 and Q ∗ index of 0.726 demonstrate acceptable diagnostic precision of ANG in identifying BCa. Conclusion. This meta-analysis showed that ANG could be a fair biomarker for the diagnosis of BCa patients.

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Diagnostic Role of Extracellular Vesicles in Cancer: A Comprehensive Systematic Review and Meta-Analysis

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.705791 ◽

2021 ◽

Vol 9 ◽

Author(s):

Shu-ya Liu ◽

Yin Liao ◽

Hossein Hosseinifard ◽

Saber Imani ◽

Qing-lian Wen

Keyword(s):

Likelihood Ratio ◽

Extracellular Vesicles ◽

Cancer Progression ◽

Cancer Diagnosis ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Summary Receiver Operating Characteristic ◽

Diagnostic Efficacy

Background: Cancer-derived extracellular vesicles (EVs) are regarded to have significant function in most steps during cancer progression. This meta-analysis aims to investigate the accuracy of EVs as a biomarker in cancer diagnosis.Methods: The diagnostic efficacy of EVs for different cancers was assessed using pooled sensitivity and specificity, diagnostic odds ratio (DOR), and overall area under the curve (AUC) of the summary receiver operating characteristic (SROC). The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were verified to estimate the diagnostic efficacy of EV at a clinical level.Results: In all, 6,183 cancer patients and 2,437 healthy controls from 75 eligible studies reported in 42 publications were included in the study. The overall pooled sensitivity, specificity, PLR, NLR, and DOR were 0.62 (95% CI: 0.60–0.63), 0.76 (95% CI: 0.75–0.78), 3.07 (95% CI: 2.52–3.75), 0.34 (95% CI: 0.28–0.41), and 10.98 (95% CI: 7.53–16.00), respectively. Similarly, the AUC of the SROC was 0.88, indicating a high conservation of EVs as an early diagnostic marker. Furthermore, subgroup analysis suggested that the use of small EVs as a biomarker was more accurate in serum-based samples of nervous system cancer (p < 0.001). As a result, ultracentrifugation and quantification and size determination methods, such as Western blotting and ELISA were the most reliable identification methods for EV detection. We also indicated that increased secretion of EVs made them a capable biomarker for diagnosing cancer in elderly European individuals.Conclusions: Our study provides evidence that EVs are a promising non-invasive biomarker for cancer diagnosis. Well-designed cohort studies should be conducted to warrant the clinical diagnostic value of EVs.

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