Dataset Information

Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis.

ABSTRACT:

Objectives

Accurate subtype classification in primary aldosteronism (PA) is critical in assessing the optimal treatment options. This study aimed to evaluate the diagnostic accuracy of adrenal imaging for unilateral PA classification.

Methods

Systematic searches of PubMed, EMBASE and the Cochrane databases were performed from 1 January 2000 to 1 February 2020, for all studies that used CT or MRI in determining unilateral PA and validated the results against invasive adrenal vein sampling (AVS). Summary diagnostic accuracies were assessed using a bivariate random-effects model. Subgroup analyses, meta-regression and sensitivity analysis were performed to explore the possible sources of heterogeneity.

Result

A total of 25 studies, involving a total of 4669 subjects, were identified. The overall analysis revealed a pooled sensitivity of 68% (95% CI: 61% to 74%) and specificity of 57% (95% CI 50% to 65%) for CT/MRI in identifying unilateral PA. Sensitivity was higher in the contrast-enhanced (CT) group versus the traditional CT group (77% (95% CI 66% to 85%) vs 58% (95% CI 50% to 66%). Subgroup analysis stratified by screening test for PA showed that the sensitivity of the aldosterone-to-renin ratio (ARR) group was higher than that of the non-ARR group (78% (95% CI 69% to 84%) vs 66% (95% CI 58% to 72%)). The diagnostic accuracy of PA patients aged ?40 years was reported in four studies, and the overall sensitivity was 71%, with 79% specificity. Meta-regression revealed a significant impact of sample size on sensitivity and of age and study quality on specificity.

Conclusion

CT/MRI is not a reliable alternative to invasive AVS without excellent sensitivity or specificity for correctly identifying unilateral PA. Even in young patients (?40 years), 21% of patients would have undergone unnecessary adrenalectomy based on imaging results alone.

SUBMITTER: Zhou Y

PROVIDER: S-EPMC7780716 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis.

Zhou Yaqiong Y Wang Dan D Jiang Licheng L Ran Fei F Chen Sichao S Zhou Peng P Wang Peijian P

BMJ open 20201231 12

<h4>Objectives</h4>Accurate subtype classification in primary aldosteronism (PA) is critical in assessing the optimal treatment options. This study aimed to evaluate the diagnostic accuracy of adrenal imaging for unilateral PA classification.<h4>Methods</h4>Systematic searches of PubMed, EMBASE and the Cochrane databases were performed from 1 January 2000 to 1 February 2020, for all studies that used CT or MRI in determining unilateral PA and validated the results against invasive adrenal vein s ...[more]

PMID: 33384386

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Project description:ObjectivesTo assess the diagnostic accuracy of self-diagnosis compared with a clinical diagnosis for common conditions in primary care.DesignSystematic review.Meta-analysisData sourcesMedline, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews and CINAHL from inception to 25 January 2021.Study selectionEligible studies were prospective or retrospective studies comparing the results of self-diagnosis of common conditions in primary care to a relevant clinical diagnosis or laboratory reference standard test performed by a healthcare service provider. Studies that considered self-testing only were excluded.Data extractionTwo authors independently extracted data using a predefined data extraction form and assessed risk of bias using Quality Assessment of Diagnostic Accuracy Studies-2.Methods and results5047 records identified 18 studies for inclusion covering the self-diagnosis of three common conditions: vaginal infection (five studies), common skin conditions (four studies) and HIV (nine studies). No studies were found for any other condition. For self-diagnosis of vaginal infection and common skin conditions, meta-analysis was not appropriate and data were reported narratively. Nine studies, using point-of-care oral fluid tests, reported on the accuracy of self-diagnosis of HIV and data were pooled using bivariate meta-analysis methods. For these nine studies, the pooled sensitivity was 92.8% (95% CI, 86% to 96.5%) and specificity was 99.8% (95% CI, 99.1% to 99.9%). Post hoc, the robustness of the pooled findings was tested in a sensitivity analysis only including four studies using laboratory testing as the reference standard. The pooled sensitivity reduced to 87.7% (95% CI, 81.4% to 92.2%) and the specificity remained the same. The quality of all 18 included studies was assessed as mixed and overall study methodology was not always well described.Conclusions and implications of key findingsOverall, there was a paucity of evidence. The current evidence does not support routine self-diagnosis for vaginal infections, common skin conditions and HIV in primary care.Prospero registration numberCRD42018110288.

Dataset Information

Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis.

Objectives

Methods

Result

Conclusion

Publications

Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis.

Similar Datasets

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