Accuracy of multiparametric magnetic resonance imaging for detecting extracapsular extension in prostate cancer: a systematic review and meta-analysis

Objective: To evaluate the diagnostic accuracy of multiparametric MRI (mpMRI) for detecting extracapsular extension (ECE) in patients with prostate cancer (PCa). Methods and materials: We searched MEDLINE, PubMed, Embase and the Cochrane library up to December 2018. We included studies that used mpMRI to differentiate ECE from organ-confined PCa with a combination of T2 weighted imaging (T2WI), diffusion-weighted imaging, and dynamic contrast-enhanced MRI. All studies included had pathological diagnosis with radical prostatectomy. Two reviewers independently assessed the methodological quality of included studies by using Quality Assessment of Diagnostic Accuracy Studies 2 tool. We calculated pooled sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios and receiver operating characteristic curve for mpMRI from 2 × 2 tables. Results: A total of 17 studies that comprised 3374 participants were included. The pooled data showed a sensitivity of 0.55 (95% confidence interval 0.43, 0.66]) and specificity of 0.87 (95% confidence interval 0.82, 0.91) for extracapsular extension detection in PCa. Conclusion: First, our meta-analysis shows moderate sensitivity and high specificity for mpMRI to differentiate ECE from organ-confined prostate cancer before surgery. Second, our meta-analysis shows that mpMRI had no significant differences in performance compared with the former meta-analysis with use of T2WI alone or with additional functional MRI. Advances in knowledge: It is the first meta-analysis to evaluate the accuracy of mpMRI in combination of TWI, diffusion-weightedimaging and dynamiccontrast-enhanced-MRI for extracapsular extension detection.

Download Full-text

Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1460-y ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Tao Huang ◽

Jian Liu ◽

Yupeng Ma ◽

Dongsheng Zhou ◽

Liang Chen ◽

...

Keyword(s):

Rotator Cuff ◽

Meta Analysis ◽

Characteristic Curve ◽

Mr Arthrography ◽

Diagnostic Value ◽

Rotator Cuff Tears ◽

Cochrane Library ◽

Predictive Values ◽

Partial Thickness ◽

Sensitivity Specificity

Abstract Background Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. Methods Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67–0.85), 0.98 (95% CI, 0.95–0.99), 73.01 (95% CI, 35.01–152.26), and 0.88 (95% CI, 0.85–0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66–0.86) and 0.96 (95% CI, 0.81–0.99), and 37.12 (95% CI, 8.08–170.64) and 0.82 (95% CI, 0.78–0.85), respectively. Conclusions This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.

Download Full-text

Performance of Serum Glypican 3 in Diagnosis of Hepatocellular Carcinoma: A meta-analysis

Annals of Hepatology ◽

10.5604/01.3001.0012.2121 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

Dahai Xu ◽

Chang Su ◽

Liang Sun ◽

Yuanyuan Gao ◽

Youjun Li

Keyword(s):

Hepatocellular Carcinoma ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Operating Characteristic ◽

Web Of Science ◽

Meta Analysis ◽

Characteristic Curve ◽

Positive Control ◽

Cochrane Library ◽

Non Invasive

Introduction and aim. Serum glypican-3 (GPC3) has been explored as a non-invasive biomarker of hepatocellular carcinoma (HCC). However, controversy remains on its diagnostic accuracy. Therefore, we aimed to conduct a systematic review and metaanalysis to evaluate the differential diagnostic accuracy of serum GPC3 between HCC and liver cirrhosis (LC) cases. Material and methods. After the strict filtering and screening of studies from NCBI, PUBMED, Clinical Trials, Cochrane library, Embase, Prospero and Web of Science databases, 11 studies were selected. All studies provided the sensitivity and specificity of GPC3 and the alpha-fetoprotein (AFP) in the HCC and LC diagnosis. The sensitivity and specificity, and the area under the receiver operating characteristic curve (AUC) were determined and compared between GPC3 and AFP, which was set as a positive control. Results. Pooled sensitivity (95% CI) and specificity (95% CI) were 0.55 (0.52-0.58) and 0.58 (0.54-0.61) for GPC3, 0.54 (0.51-0.57) and 0.83 (0.80-0.85) for AFP, and 0.85 (0.81-0.89) and 0.79 (0.73-0.84) for GPC3 + AFP, respectively. The AUCs of GPC3, AFP and GPC3 + AFP were 0.7793, 0.7867 and 0.9366, respectively. GPC3 had a nearly similar sensitivity as AFP, while the specificity and AUC of GPC3 was lower than that of AFP. The combination of GPC3 and AFP yielded a better sensitivity and AUC than GPC3 or AFP. Conclusion. Serum GPC3 is inferior to AFP in the differential diagnosis between HCC and LC. However, the combination of GPC3 and AFP exhibited a much better performance.

Download Full-text

Systematic Review & Meta-Analysis of the Diagnostic Accuracy of Prostate Specific Antigen (PSA) for the Detection of Prostate Cancer in Symptomatic Patients

10.21203/rs.3.rs-994688/v1 ◽

2021 ◽

Author(s):

Samuel William David Merriel ◽

Lucy Pocock ◽

Emma Gilbert ◽

Sam Creavin ◽

Fiona M Walter ◽

...

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Prostate Specific Antigen ◽

Meta Analysis ◽

Specific Antigen ◽

Database Search ◽

Cochrane Library ◽

Inclusion Criteria ◽

Reference Test ◽

Psa Testing

Abstract BackgroundProstate Specific Antigen (PSA) is a commonly used test to detect prostate cancer. Attention has mostly focused on the use of PSA in screening asymptomatic patients, but the diagnostic accuracy of PSA for prostate cancer in patients with symptoms is less well understood.MethodsA systematic database search was conducted of Medline, EMBASE, Web of Science, and the Cochrane library. Studies reporting the diagnostic accuracy of PSA for prostate cancer in patients with symptoms were included. Two investigators independently assessed the titles and abstracts of all database search hits and full texts of potentially relevant studies against the inclusion criteria, and data extracted into a proforma. Study quality was assessed using the QUADAS-2 tool by two investigators independently. Summary estimates of diagnostic accuracy were calculated with meta-analysis using bivariate mixed effects regression.Results563 search hits were assessed by title and abstract after de-duplication, with 75 full text papers reviewed. 19 studies met the inclusion criteria, 18 of which were conducted in secondary care settings (one from a screening study cohort). All studies used histology obtained by Transrectal Ultrasound guided biopsy (TRUS) as a reference test, usually only for patients with elevated PSA or abnormal prostate examination. Pooled data from 14,489 patients found estimated sensitivity of PSA for prostate cancer was 0.93 (95% CI 0.88, 0.96) and specificity was 0.20 (95% CI 0.12, 0.33). The area under the receiving-operator characteristic curve was 0.72 (95% CI 0.68, 0.76). All studies were assessed as having a high risk of bias in at least one QUADAS-2 domain.ConclusionsCurrently available evidence suggests PSA is highly sensitive but poorly specific for prostate cancer detection. However, significant limitations in study design and reference test reduces the certainty of this estimate. There is very limited evidence for the performance of PSA in primary care, the healthcare setting where most PSA testing is performed.

Download Full-text

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Journal of Clinical Medicine ◽

10.3390/jcm8112005 ◽

2019 ◽

Vol 8 (11) ◽

pp. 2005 ◽

Cited By ~ 3

Author(s):

Cornelis Maarten de Mooij ◽

Martijn Maassen van den Brink ◽

Audrey Merry ◽

Thais Tweed ◽

Jan Stoot

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Anastomotic Leakage ◽

High Specificity ◽

Early Postoperative Period ◽

Cancer Surgery ◽

Cochrane Library ◽

Diagnostic Tools ◽

Gastroesophageal Cancer ◽

Predictive Values

Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.

Download Full-text

Urinary EN-2 to predict prostate cancer: Systematic review and meta-analysis

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.07.656 ◽

2017 ◽

Vol 63 (7) ◽

pp. 656-661 ◽

Cited By ~ 1

Author(s):

Maria Inês da Rosa ◽

Eduardo Ronconi Dondossola ◽

Maria Cecilia Manenti Alexandre ◽

Kristian Madeira ◽

Florentino de Araújo Cardoso ◽

...

Keyword(s):

Prostate Cancer ◽

Meta Analysis ◽

Specific Antigen ◽

High Specificity ◽

Cochrane Library ◽

Language Restriction ◽

Comprehensive Search ◽

Control Disease ◽

Low Sensitivity ◽

Abstract Screening

Summary Introduction: Prostate cancer is the second type of cancer diagnosed and the fifth cause of death in men worldwide. Early diagnosis helps to control disease progression. Currently, prostate specific antigen is the standard biomarker, as it has a broad scope of identification and, thus, new and more specific biomarkers must be studied. Objective: To evaluate the accuracy of engrailed-2 protein (EN2) in urine as a prostate cancer biomarker. Method: A comprehensive search was conducted in the period from January 2005 to July 2016 using the following electronic databases: Medline (PubMed), Embase, Cochrane Library and Lilacs. The keywords used in the databases were: "engrailed-2," "EN2," "prostatic neoplasms." The search was limited to humans and there was no language restriction. Critical appraisal of the included studies was performed according to Quadas-2. Statistical analysis was performed using Meta-DiSc® and RevMan 5.3 softwares. Results: A total of 248 studies were identified. After title and abstract screening, 231 studies were removed. A total of 17 studies were read in full and two studies were included in the meta-analysis. The pooled sensitivity was 66% (95CI 0.56-0.75) and specificity was 89% (95CI 0.86-0.92). The DOR was 15.08 (95CI 8.43-26.97). Conclusion: The EN2 test showed high specificity (89%) and low sensitivity (66%).

Download Full-text

The value of ultrasound in diagnosis of pneumoperitoneum in emergent or critical conditions: A meta-analysis

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918805668 ◽

2018 ◽

Vol 26 (2) ◽

pp. 111-117 ◽

Cited By ~ 1

Author(s):

Libing Jiang ◽

Jing Wu ◽

Xia Feng

Keyword(s):

Confidence Interval ◽

Likelihood Ratio ◽

Meta Analysis ◽

Characteristic Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Abdominal Ultrasound ◽

Critical Conditions ◽

Cochrane Library ◽

Summary Receiver Operating Characteristic

Background: Hollow organs perforation is a life-threatening condition. Early diagnosis and emergent intervention are important. Bedside ultrasound may be an alternative diagnostic tool for this condition. Objective: The aim of this study was to explore the diagnostic value of ultrasound of pneumoperitoneum in emergent or critical conditions through meta-analysis. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for potential studies. Then, two reviewers performed the processes of study selection, data extraction, and quality assessment independently. Finally, diagnostic indexes were analyzed with STATA 12.0 software (Serial No. 40120519635). Results: A total of five studies with moderate to high quality were eligible for meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and their 95% confidence interval were 0.91 (95% confidence interval = 0.86–0.94), 0.96 (95% confidence interval = 0.75–0.99), 22.05 (95% confidence interval = 3.10–156.96), and 0.10 (95% confidence interval = 0.07–0.15), respectively. The area under the summary receiver operating characteristic curve was 0.92 (95% confidence interval = 0.90–0.94). Conclusion: Abdominal ultrasound is a useful alternative tool in diagnosing of pneumoperitoneum. However, due to limited evidence, it is not yet indicated for routine clinical use.

Download Full-text

Meta-Analysis of Antinuclear Antibodies in the Diagnosis of Antimitochondrial Antibody-Negative Primary Biliary Cholangitis

Gastroenterology Research and Practice ◽

10.1155/2019/8959103 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Qian Zhang ◽

Zhiqiang Liu ◽

Shanshan Wu ◽

Weijia Duan ◽

Sha Chen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Antinuclear Antibodies ◽

Meta Analysis ◽

High Specificity ◽

Diagnostic Value ◽

Cochrane Library ◽

Primary Biliary Cholangitis ◽

Summary Receiver Operating Characteristic ◽

Random Effects Models ◽

Antimitochondrial Antibody

Objective. The diagnostic value of antinuclear antibodies (ANAs) including anti-gp210 and anti-sp100 for primary biliary cholangitis/cirrhosis (PBC) has been widely reported. However, their diagnostic performances for antimitochondrial antibody- (AMA-) negative PBC were less well elucidated. Therefore, the aim of the current meta-analysis was to evaluate the diagnostic accuracy of ANAs in patients with AMA-negative PBC. Materials and Methods. Literature on the diagnostic value of biomarkers for AMA-negative PBC was systematically searched in PubMed, MEDLINE, EMBASE, and the Cochrane Library. The qualities of the retrieved studies were assessed by the Quality Assessment of Diagnostic Accuracy Studies-version 2 (QUADAS-2) scale. Pooled sensitivity and specificity of the biomarkers were calculated with random-effects models. The areas under the summary receiver operating characteristic (AUSROC) curves were used to evaluate the overall diagnostic performance of ANAs. Results. A total of 11 studies (400 AMA-negative PBC patients and 6217 controls) were finally included in the meta-analysis. ANAs had an overall sensitivity of 27% (95% CI: 20%, 35%) and specificity of 98% (95% CI: 97%, 99%). The pooled sensitivities for anti-gp210 and anti-sp100 were 23% (95% CI: 13%, 37%) and 25% (95% CI: 13%, 43%), respectively, and their specificities were 99% (95% CI: 97%, 100%) and 97% (95% CI: 93%, 98%), respectively. Conclusions. ANAs exhibited high specificity but low sensitivity and therefore could be used as reliable biomarkers to reduce the necessity of liver histology.

Download Full-text

Basal Follicle-Stimulating Hormone and Peak Gonadotropin Levels after Gonadotropin-Releasing Hormone Infusion Show High Diagnostic Accuracy in Boys with Suspicion of Hypogonadotropic Hypogonadism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-2732 ◽

2010 ◽

Vol 95 (6) ◽

pp. 2811-2818 ◽

Cited By ~ 22

Author(s):

Romina P. Grinspon ◽

María Gabriela Ropelato ◽

Silvia Gottlieb ◽

Ana Keselman ◽

Alicia Martínez ◽

...

Keyword(s):

Confidence Interval ◽

Diagnostic Accuracy ◽

De Novo ◽

Hypogonadotropic Hypogonadism ◽

High Specificity ◽

Diagnostic Efficiency ◽

Infusion Test ◽

Predictive Values ◽

Constitutional Delay ◽

Gnrh Infusion

Abstract Context: Differential diagnosis between hypogonadotropic hypogonadism (HH) and constitutional delay of puberty in boys is challenging. Most tests use an acute GnRH stimulus, allowing only the release of previously synthesized gonadotropins. A constant GnRH infusion, inducing de novo gonadotropin synthesis, may allow a better discrimination. Objective: We evaluated the diagnostic accuracy of basal and peak gonadotropins after GnRH infusion, measured by ultrasensitive assays, to confirm the diagnosis in boys with suspected HH. Design and Setting: We conducted a validation study following Standards for Reporting of Diagnostic Accuracy criteria at a tertiary public hospital. Patients and Methods: A GnRH iv infusion test was performed in 32 boys. LH and FSH were determined by immunofluorometric assay at 0–120 min. Diagnosis Ascertainment: The following diagnoses were ascertained: complete HH (n = 19; testes < 4 ml at 18 yr), partial HH (n = 6; testes enlargement remained arrested for ≥1 yr or did not reach 15 ml), and constitutional delay of puberty (n = 7; testes ≥ 15 ml at 18 yr). Main Outcome Measures: Sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency were assessed. Results: Basal FSH less than 1.2 IU/liter confirmed HH with specificity of 1.00 (95% confidence interval = 0.59–1.00), rendering GnRH infusion unnecessary. In patients with basal FSH of at least 1.2 IU/liter, the coexistence of peak FSH less than 4.6 IU/liter and peak LH less than 5.8 IU/liter after GnRH infusion had high specificity (1.00; 95% confidence interval = 0.59–1.00) and diagnostic efficiency (76.9%) for HH. Conclusions: Basal FSH less than 1.2 IU/liter confirms HH, which precludes from further testing, reducing patient discomfort and healthcare system costs. In patients with basal FSH of at least 1.2 IU/liter, a GnRH infusion test has a high diagnostic efficiency.

Download Full-text

Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818814948 ◽

2018 ◽

Vol 11 ◽

pp. 175628481881494

Author(s):

Ben Glover ◽

Nisha Patel ◽

Hutan Ashrafian ◽

Julian Teare

Keyword(s):

Confidence Interval ◽

Diagnostic Accuracy ◽

Real Time ◽

Image Enhancement ◽

Diagnostic Performance ◽

Meta Analysis ◽

Colonic Polyps ◽

Colorectal Polyps ◽

Cochrane Library ◽

Optical Diagnosis

Objective: i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size. Data sources: The databases of Medline, Embase and the Cochrane Library were searched for relevant studies. Methods: A bivariate random effects model was used to produce pooled sensitivity and specificity values, and univariable meta-regression was applied for subgroup analysis. Results: The meta-analysis included 15 studies, and diagnosis of 2817 polyps. The area under the hierarchical summary receiver-operating characteristic curve was 0.96. The pooled sensitivity of i-scan optical diagnosis was 0.92 (95% confidence interval 0.85–0.95). The specificity was 0.90 (95% confidence interval 0.83–0.94). Conclusions: This meta-analysis updates and summarizes the available evidence concerning the diagnostic performance of i-scan for small colorectal polyps. An acceptable degree of accuracy was found, showing potential to support a ‘resect and discard’ strategy for colonic polyps. There was not found to be a significant difference in diagnostic performance between different clinical settings (i.e. teaching hospitals or general hospitals).

Download Full-text

Diagnostic accuracy of MRI for detecting cervical invasion in patients with endometrial carcinoma: A meta-analysis

10.21203/rs.3.rs-22965/v1 ◽

2020 ◽

Author(s):

Qiu Bi ◽

Guoli Bi ◽

Junna Wang ◽

Jie Zhang ◽

Hongliang Li ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Endometrial Carcinoma ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Preoperative Assessment ◽

High Specificity ◽

Cochrane Library ◽

Dce Mri ◽

3.0 T ◽

Magnetic Resonance Imaging Mri

Abstract Background: Clinical management and the prognosis of endometrial cancer is closely related to cervical invasion. The diagnostic performance of MRI for detecting cervical invasion has not been comprehensively assessed. We aim to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative assessment of cervical invasion and to analyze the influence of different imaging protocols in patients with endometrial carcinoma.Methods: An extensive search of articles about MRI in assessing cervical invasion in patients with endometrial carcinoma was performed in PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials from January 2000 to July 2019. Two reviewers independently evaluated the methodological quality of each study by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Diagnostic accuracy results and additional useful information were extracted. Pooled estimation data was obtained by statistical analysis. Results: A total of 42 eligible studies were included in the meta-analysis. Significant evidence of heterogeneity was found for detecting cervical invasion (I2 = 74.1%, P = 0.00 for sensitivity and I2 = 56.2%, P = 0.00 for specificity). And the pooled sensitivity and specificity of MRI were 0.58 and 0.95 respectively. The use of higher field strength (3.0 T) demonstrated higher pooled sensitivity (0.74). Using diffusion-weighted imaging (DWI) alone presented higher pooled sensitivity (0.86) than using other sequences. Studies that used dynamic contrast-enhanced MRI (DCE-MRI) alone showed higher sensitivity (0.80) and specificity (0.96) than that used T2-weighted image (T2WI) alone.Conclusions: MRI shows high specificity for detecting cervical infiltration in endometrial carcinoma. Using DWI or a 3.0-T device may improve the pooled sensitivity. The use of DCE-MRI demonstrate higher pooled sensitivity and specificity than T2WI.

Download Full-text