Diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure: a systematic review and meta-analysis.
Ontology highlight
ABSTRACT: Purpose
This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis.Methods
A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT.Results
The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%).Conclusion
AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy.
SUBMITTER: Desmond T
PROVIDER: S-EPMC8255337 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Aim:To assess the diagnostic performance of lateral radiograph of the neck for supraglottitis in adults and children. Methods:Electronic database searches (including PubMed, EMBASE, CINAHL, Web of Science, and WHO International Clinical Trials Registry Platform) were carried out through July 2014. Citations of included studies and recent narrative reviews were searched. Studies that compared lateral radiograph of the neck with a reference standard of direct/indirect laryngoscopy were included. Two reviewers independently assessed the methodological quality of included studies by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Results:Of 2,088 potentially relevant citations, two single-gate (cohort) studies and six two-gate (case-control) studies were identified. These included studies of design are at the moderate or high risk of bias in QUADAS-2. The pooled sensitivity from bivariate random-effects regression was 92.9% (95% confidence interval [CI], 88.5-95.9%) and the pooled specificity was 89.2% (95% CI, 85.9-91.9%), but the diagnostic value would be overestimated because of selection bias in the six two-gate studies. The sensitivity and specificity of the single-gate studies were 100.0% (95% CI, 92.2-100.0%) and 30.6% (95% CI, 15.5-35.6%) in children and 81.0% (95% CI, 78.2-93.2%) and 85.7% specificity (95% CI, 78.2-93.2%) in adults. Conclusion:This study determines that there are insufficient studies of lateral neck radiograph for detecting supraglottitis. Lateral radiograph of the neck seems to have moderate accuracy for detecting supraglottitis. Further approximately unbiased studies are needed to obtain more valid and reliable estimates of test accuracy.
| S-EPMC5667265 | biostudies-literature
Project description:BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Early diagnosis of AF is crucial for preventing AF-related morbidity, mortality, and economic burden, yet the detection of the disease remains challenging. The 12-lead electrocardiogram (ECG) is the gold standard for the diagnosis of AF. Because of technological advances, ambulatory devices may serve as convenient screening tools for AF.ObjectiveThe objective of this review was to investigate the diagnostic accuracy of 2 relatively new technologies used in ambulatory devices, non-12-lead ECG and photoplethysmography (PPG), in detecting AF. We performed a meta-analysis to evaluate the diagnostic accuracy of non-12-lead ECG and PPG compared to the reference standard, 12-lead ECG. We also conducted a subgroup analysis to assess the impact of study design and participant recruitment on diagnostic accuracy.MethodsThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE and EMBASE were systematically searched for articles published from January 1, 2015 to January 23, 2021. A bivariate model was used to pool estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating curve (SROC) as the main diagnostic measures. Study quality was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool.ResultsOur search resulted in 16 studies using either non-12-lead ECG or PPG for detecting AF, comprising 3217 participants and 7623 assessments. The pooled estimates of sensitivity, specificity, PLR, NLR, and diagnostic odds ratio for the detection of AF were 89.7% (95% CI 83.2%-93.9%), 95.7% (95% CI 92.0%-97.7%), 20.64 (95% CI 10.10-42.15), 0.11 (95% CI 0.06-0.19), and 224.75 (95% CI 70.10-720.56), respectively, for the automatic interpretation of non-12-lead ECG measurements and 94.7% (95% CI 93.3%-95.8%), 97.6% (95% CI 94.5%-99.0%), 35.51 (95% CI 18.19-69.31), 0.05 (95% CI 0.04-0.07), and 730.79 (95% CI 309.33-1726.49), respectively, for the automatic interpretation of PPG measurements.ConclusionsBoth non-12-lead ECG and PPG offered high diagnostic accuracies for AF. Detection employing automatic analysis techniques may serve as a useful preliminary screening tool before administering a gold standard test, which generally requires competent physician analyses. Subgroup analysis indicated variations of sensitivity and specificity between studies that recruited low-risk and high-risk populations, warranting future validity tests in the general population.Trial registrationPROSPERO International Prospective Register of Systematic Reviews CRD42020179937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179937.
| S-EPMC8065566 | biostudies-literature
Project description:PurposeTo quantify interquadrant differences in anterior chamber angle (ACA) configuration assessed on gonioscopy, EyeCam, and anterior segment optical coherence tomography (AS-OCT) in a cohort of Chinese Americans.MethodsSubjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, CA. Each subject underwent a complete ocular exam, including gonioscopy, EyeCam, and AS-OCT, under dark ambient lighting. Gonioscopy and AS-OCT imaging and EyeCam image grading were performed by trained ophthalmologists.ResultsSeven hundred nine eyes from 709 subjects were analyzed. Less anatomic variation among the quadrants was detected on gonioscopy and EyeCam compared with AS-OCT (P < 0.05). The mean gonioscopy grade, EyeCam grade, and AS-OCT measurement for each quadrant varied by up to 10.3%, 6.4%, and 46.2% of the superior quadrant value, respectively. There were significant interquadrant differences (P < 0.05) among mean AOD750 measurements when grouping by quadrant and gonioscopy or EyeCam grade. Mean AOD750 measurements were smallest for the superior quadrant by between 14.3% and 38.1% and 17.4% and 37.9% on gonioscopy and EyeCam, respectively, compared with other quadrants.ConclusionsGonioscopy and EyeCam significantly underrepresent anatomic variations of the ACA compared with AS-OCT. Gonioscopy or EyeCam grades from different quadrants do not appear to be comparable or interchangeable, which supports reconsideration of current definitions and methods used to diagnose and manage primary angle closure disease.Translational relevanceAS-OCT imaging raises concerns about current clinical definitions and methods that rely gonioscopy or EyeCam to assess the ACA.
| S-EPMC6438105 | biostudies-literature
Project description:Objective:To systematically evaluate the diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. Methods:We searched EMBASE (OvidSP), MEDLINE (OvidSP), the Cochrane Library, and Web of Science to identify diagnostic accuracy trials of monofilament tests for detecting diabetic peripheral neuropathy. We used a hierarchical summary receiver operating characteristics (HSROC) model to conduct the meta-analysis of diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. Results:A total of 19 comparative trials met the inclusion criteria and were part of the qualitative synthesis. Eight trials using nerve conduction studies as the reference standard were selected for the meta-analysis. The pooled sensitivity and specificity of monofilament tests for detecting diabetic peripheral neuropathy were 0.53 (95% confidence interval (CI) 0.32 to 0.74) and 0.88 (95% CI 0.78 to 0.94), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.56 (95% CI 2.93 to 7.10) and 0.53 (95% CI 0.35 to 0.81), respectively. Conclusions:Our review indicated that monofilament tests had limited sensitivity for screening diabetic peripheral neuropathy. The clinical use of the monofilament test in the evaluation of diabetic peripheral neuropathy cannot be encouraged based on currently available evidence.
| S-EPMC5651135 | biostudies-literature
Project description:BackgroundArtificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies including polyps, neoplasms, and inflammatory bowel disease.MethodsWe searched PubMed, CINAHL, Wiley Cochrane Library, and Web of Science electronic databases to identify studies assessing the diagnostic performance of AI models for GI luminal pathologies. We extracted binary diagnostic accuracy data and constructed contingency tables to derive the outcomes of interest: sensitivity and specificity. We performed a meta-analysis and hierarchical summary receiver operating characteristic curves (HSROC). The risk of bias was assessed using Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Subgroup analyses were conducted based on the type of GI luminal disease, AI model, reference standard, and type of data used for analysis. This study is registered with PROSPERO (CRD42021288360).FindingsWe included 73 studies, of which 31 were externally validated and provided sufficient information for inclusion in the meta-analysis. The overall sensitivity of AI for detecting GI luminal pathologies was 91.9% (95% CI: 89.0-94.1) and specificity was 91.7% (95% CI: 87.4-94.7). Deep learning models (sensitivity: 89.8%, specificity: 91.9%) and ensemble methods (sensitivity: 95.4%, specificity: 90.9%) were the most commonly used models in the included studies. Majority of studies (n = 56, 76.7%) had a high risk of selection bias while 74% (n = 54) studies were low risk on reference standard and 67% (n = 49) were low risk for flow and timing bias.InterpretationThe review suggests high sensitivity and specificity of AI models for the detection of GI luminal pathologies. There is a need for large, multi-center trials in both high income countries and low- and middle- income countries to assess the performance of these AI models in real clinical settings and its impact on diagnosis and prognosis.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288360], identifier [CRD42021288360].
| S-EPMC9672666 | biostudies-literature
Project description:OBJECTIVE:Midkine (MDK) has been proposed as one of the most promising markers for hepatocellular carcinoma (HCC). This meta-analysis was conducted to compare the diagnostic accuracy of MDK and ?-fetoprotein (AFP) for HCC. METHODS:We systematically searched PubMed/MEDLINE, Ovid/EMBASE, and the Cochrane Library for all relevant studies up to 18 May 2019. The Revised Quality Assessment for Studies of Diagnostic Accuracy tool (QUADAS-2) was used to assess the methodological quality of the included studies. The sensitivity, specificity, and the area under the curve (AUC) of MDK and AFP for detecting HCC were pooled using random-effects model. RESULTS:Seventeen studies from five articles with a total of 1122 HCC patients and 2483 controls were included. The summary estimates using MDK and AFP for detecting HCC were as follows: sensitivity, 85 vs 52%, specificity, 82 vs 94%, and AUC, 0.90 vs 0.83. The summary estimates using MDK and AFP for detecting hepatitis virus-related HCC as follows: sensitivity, 93 vs 74%, specificity, 85 vs 97%, and AUC, 0.95 vs 0.97. The summary estimates using MDK and AFP for detecting early-stage HCC were as follows: sensitivity, 83.5 vs 44.4%, specificity, 81.7 vs 84.8%, and AUC, 0.87 vs 0.52. The summary estimates using MDK for detecting AFP-negative HCC as follows: sensitivity, 88.5%, specificity, 83.9%, and AUC, 0.91. CONCLUSION:MDK is more accurate than AFP in diagnosing HCC, especially for early-stage HCC and AFP-negative HCC. Both MDK and AFP had excellent diagnostic performance for hepatitis virus-related HCC.
| S-EPMC7087326 | biostudies-literature
Project description:Anaplastic lymphoma kinase (ALK) gene fusion has been reported in 3?5% non-small cell lung carcinoma (NSCLC) patients, and polymerase chain reaction (PCR) is commonly used to detecting the gene status, but the diagnostic capacity of it is still controversial. A systematic review and meta-analysis was conducted to clarify the diagnostic accuracy of PCR for detecting ALK gene rearrangement in NSCLC patients.18 articles were enrolled, which included 21 studies, involving 2800 samples from NSCLC patients. The overall pooled parameters were calculated: sensitivity was 92.4% [95% confidence interval (CI): 82.2%-97.0%], specificity was 97.8% [95% CI: 95.1%-99.0%], PLR was 41.51 [95% CI: 18.10-95.22], NLR was 0.08 [95% CI: 0.03-0.19], DOR was 535.72 [95% CI: 128.48-2233.79], AUROC was 0.99 [95% CI: 0.98-1.00].Relevant articles were searched from PubMed, EMBASE, Web of Science, Cochrane library, American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), China National Knowledge Infrastructure (CNKI), China Wan Fang databases and Chinese biomedical literature database (CBM). Diagnostic capacity of PCR test was assessed by the pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic (AUROC).Based on the results from this review, PCR has good diagnostic performance for detecting the ALK gene fusion in NSCLC patients. Moreover, due to the poor methodology quality of the enrolled trials, more well-designed multi-center trials should be performed.
| S-EPMC5650430 | biostudies-literature
Project description:BackgroundMost of national schistosomiasis elimination programmes in Asia are relying on stool examination, particularly Kato Katz stool examination technique for regular transmission monitoring. However, the Kato-Katz technique has shown low sensitivity for the detection of light-intensity infections, and therefore highly sensitive diagnostic tools are urgently required to monitor prevalence of infection in low transmission settings. The objective of this systematic review was to evaluate and synthesize the performance of diagnostic tests for detecting Schistosoma japonicum and S. mekongi infection in people living in endemic areas.Methodology/principal findingsWe comprehensively searched these nine electronic databases and other resources until July 2019, with no language or publication limits: PubMed, EMBASE, MEDLINE, Web of Science, BIOSIS Citation Index, HTA, CINAHL PLUS, The Cochrane Library, and PsycINFO. We included original studies that assessed diagnostic performance using antibody, antigen, and molecular tests with stool examination test as a reference standard. Two reviewers independently extracted a standard set of data and assessed study quality. We estimated the pooled estimates of sensitivity and specificity for each index test. We used diagnostic odds ratio to determine the overall accuracy and hierarchical summary receiver operating characteristics (HSROC) curve to assess the index tests performance. Fifteen studies (S. japonicum [n = 13] and S. mekongi [n = 2]) testing 15,303 participants were included in the review. Five studies reported performance of enzyme-linked immunosorbent assay (ELISA), seven studies reported indirect hemagglutination assay (IHA), and four studies reported polymerase chain reaction (PCR) for detecting S. japonicum. The pooled sensitivity and specificity were 0.93 (95% CI: 0.84-0.98) and 0.40 (95% CI: 0.29-0.53) for ELISA, 0.97 (95% CI: 0.90-0.99) and 0.66 (95% CI: 0.58-0.73) for IHA, and 0.89 (95% CI: 0.71-0.96) and 0.49 (95% CI: 0.29-0.69) for PCR respectively. A global summary indicated the best performance for IHA, closely followed by ELISA. We were unable to perform meta-analysis for S. mekongi due to insufficient number of studies.Conclusions/significanceIHA showed the highest detection accuracy for S. japonicum. Further studies are needed to determine the suitable diagnostic methods to verify the absence of transmission of S. mekongi and also to compare detection accuracy against more sensitive reference standards such as PCR.
| S-EPMC7968889 | biostudies-literature
Project description:ObjectiveTo compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis.Materials and methodsOvid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies.ResultsTwenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86-0.93) and 0.90 (95% CI 0.84-0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68-0.83) and 0.83 (95% CI 0.73-0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93-0.97) for DBT and 0.86 (95% CI 0.82-0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses.ConclusionUse of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.
| S-EPMC8316775 | biostudies-literature
Project description:BackgroundDespite extensive preoperative staging, still almost half of patients with potentially resectable perihilar cholangiocarcinoma (PHC) have locally advanced or metastasized disease upon exploratory laparotomy. The value of routine staging laparoscopy (SL) in these patients remains unclear with varying results reported in the literature. The aim of the present systematic review was to provide an overview of studies on SL in PHC and to define its current role in preoperative staging.MethodsA systematic review and meta-analysis were performed in PubMed and EMBASE regarding studies providing data on the diagnostic accuracy of SL in PHC. Primary outcome measures were the overall yield and sensitivity to detect unresectable disease. Secondary outcomes were the yield and sensitivity for recent studies (after 2010) and large study cohorts (≥100 patients) and specific (metastatic) lesions. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool.ResultsFrom 173 records, 12 studies including 832 patients met the inclusion criteria. The yield of SL in PHC varied from 6.4 to 45.0 % with a pooled yield of 24.4 % [95 % confidence interval (CI) 16.4-33.4]. Sensitivity to detect unresectable disease ranged from 31.6 to 75 % with a pooled sensitivity of 52.2 % (95 % CI 47.1-57.2). Sensitivity was highest for peritoneal metastases (80.7 %, 95 % CI 70.9-88.3). Subgroup analysis revealed that the yield and sensitivity tended to be lower for studies after 2010. Considerable heterogeneity was detected among the studies.ConclusionsThe results of the pooled analyses suggest that one in four patients with potentially resectable PHC benefits from SL. Given considerable heterogeneity, a trend to lower yield in more recent studies and further improvement of preoperative imaging over time, the routine use of SL seems discouraging. Studies that identify predictors of unresectability, that enable selection of patients who will benefit the most from this procedure, are needed.
| S-EPMC5009158 | biostudies-literature