Objective To explore the accuracy and practicability of bone age assessment for the diagnosis of idiopathic precocious puberty (IPP). Methods According to the “Gold Standard”, we selected 55 girls with IPP for the study group, and 83 normal girls for the control group. We retrospectively analyzed the first left hand-wrist radiographs at the first visit. Bone ages were assessed by using a single-blind method according to the RUS (Radius Ulna and Short bones), carpale and 20 bones method (TW2). Each had 5 decision thresholds (gt;97th percentile, gt;90th percentile, gt;75th percentile, gt;50th percentile and ≤50th percentile). The diagnostic values from RUS, carpale and 20 bones methods assessing bone age were analyzed to identify the best decision threshold. Results ① Both sensitivity and specificity of the four decision thresholds were relatively higher, including gt;90th percentile of RUS (sensitivity 0.836, specificity 0.916), gt;90th percentile of carpale (sensitivity 0.746, specificity 0.916), gt;90th and gt;75th percentile of 20 bone (sensitivity 0.746, specificity 0.964 and sensitivity 0.982, specificity 0.783, respectively). ② Area under receiver operator characteristic curve (AUR): AUR of RUS 0.939 ± 0.019 (95%CI 0.902 to 0.977), AUR of carpale 0.899 ± 0.028 (95%CI 0.845 to 0.954), AUR of 20 bone 0.958 ± 0.014 (95%CI 0.930 to 0.986). No significant difference was found (F=2.03, P=0.13). ③ Agreement assessment within-observer reliability was 89.28%, and between-observer reliability was 80.3% (Kappa 0.68, u=6.87, P＜0.01). Conclusions RUS and 20 bones methods have high accuracy for the diagnosis of idiopathic precocious puberty. Considering sensitivity and specificity, we think that ＞90th percentile of RUS is the best decision threshold.
ObjectiveTo systematically review the diagnostic value of ultrasound for breast cancer with axillary sentinel lymph nodes, so as to provide evidence for clinical decision-making. MethodsWe searched the databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CBM, CNKI, WanFang Data and VIP for studies about ultrasound in the diagnosis of breast cancer with axillary sentinel lymph nodes till December 31st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and methodological quality of the included studies was evaluated. Meta-analysis was then conducted using Meta-Disc 1.4 software. ResultsA total of 12 studies involving 2 188 cases were included. The pooled results of meta-analysis showed that sensitivity and specificity were 0.75 (95%CI 0.72 to 0.77) and 0.91 (95%CI 0.89 to 0.92), respectively; positive likelihood ratio and negative likelihood ratio were 6.54 (95%CI 4.68 to 8.89) and 0.22 (95%CI 0.15 to 0.33), respectively; diagnostic odds ratio was 33.59 (95%CI 17.87 to 63.12); and the AUC was 0.934 3. ConclusionUltrasound is has relatively high value in diagnosis of breast cancer with axillary sentinel lymph nodes. However, due to the influence caused by the limited quality and various potential heterogeneity, more high quality RCTs with large sample size are needed to further verify the above conclusion.
With the development of artificial intelligence, machine learning has been widely used in diagnosis of diseases. It is crucial to conduct diagnostic test accuracy studies and evaluate the performance of models reasonably to improve the accuracy of diagnosis. For machine learning-based diagnostic test accuracy studies, this paper introduces the principles of study design in the aspects of target conditions, selection of participants, diagnostic tests, reference standards and ethics.
ObjectiveTo systematically review the diagnostic value of the combined test of serum CA153, CA125 and CEA in detection of breast cancer. MethodsClinical diagnostic tests about CA153, CA125 and CEA in patients with breast cancer were retrieved in PubMed, EMbase, CBM, The Cochrane Library (Issue 3, 2014), CNKI, VIP, and WanFang Data from January 1st, 2004 to April 16st, 2014. References of included literature were also retrieved. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Meta-analysis was then conducted using Meta-Disc 1.4 software. ResultsA total of 21 studies involving 4 263 subjects were enrolled. In all studies, the results of meta-analysis indicated that:the DOR, AUC and Q index of the single test (CA153) were 18.71 (95%CI 11.62 to 30.11), 0.858 9, and 0.789 7; while those of the combined test (CA153, CA125 and CEA) were 37.95 (95%CI 21.97 to 65.57), 0.959 1, 0.903 1. Compared with the single test, the diagnostic efficacy of the combined test was higher (Z=3.675, P=0.001 5). ConclusionCompared with the detection of CA153 alone, the combined detection of CA125, CA153 and CEA has higher efficacy and accuracy in the diagnosis of breast cancer.
Objective To evaluate the diagnosis value of purified protein derivative (PPD) antibody tests in childhood tuberculosis. Methods We reviewed 126 cases of hospitalization children tested body fluid PPD antibody by Enzyme-Linked Immunosorbent Assay (ELISA). Twenty-two them were diagnosed with tuberculosis. We determined the sensitivity, specificity, diagnostic likelihood ratio, positive prognostic value, negative prognostic value, post-test probability, respectively. Results The following accuracy statistics for the PPD body liquid antibody tests in this study: sensitivity, 45.45%; specificity, 91.35%; diagnostic likelihood ratio positive, 5.25; diagnostic likelihood ratio negative, 0.597; positive predictive value, 52.63%; negative predictive value, 88.79% and post-test probability, 48.09% in 15% of prevalence. Conclusion This study shows that body fluid PPD tests have limited value for diagnosis of tuberculosis in pediatric tuberculosis. Clinic physicians should be wary of the positive results of body fluid PPD antibody tests. The value of diagnosis is related to prevalence of tuberculosis in the specific hospital.
Objective To systematically evaluate the diagnostic value of TERC gene on high-grade squamous intraepithelial lesion (HGSIL) of the cervix. Methods Such databases as PubMed, EMbase, and The Cochrane Library were searched by March 31, 2012. According to the inclusion and exclusion criteria, the literature was screened and the data were extracted. The quality was evaluated in accordance with the quality assessment tool for diagnostic accuracy studies (QUADAS) and the meta-analysis was conducted by using Meta-Disc 1.4 software. Result A total of 12 studies involving 7 894 cases were included. The results of meta-analysis showed that the sensitivity, specificity and diagnostic odds ratios of TERC gene on HGSIL of cervix were 0.81 (95%CI 0.80 to 0.82), 0.83 (95%CI 0.82 to 0.84), 17.37 (95%CI 8.77 to 34.41), respectively. Conclusions The diagnostic value of TERC gene were medium in diagnosing HGSIL of the cervix alone, and it can be used as an optional method in clinical diagnosis.
ObjectiveTo evaluate diagnostic value of 18F-FDG PET/CT for breast cancer and axillary lymph node metastases. MethodsLiterature search was conducted in PubMed (1966 to 2013.10, EMbase (1974 to 2013.10), The Cochrane Library (Issue 8, 2013), Web of Science (1950 to 2013.10), CBM (1978 to 2013.10), WanFang Data (1990 to 2013.10) and CNKI (1994 to 2013.10) to retrieve the diagnostic studies about PET/CT in the diagnosis of breast cancer and axillary lymph node metastasis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using Meta-DiSc 1.4 software. ResultsA total of 25 studies involving 2 089 patients met the eligible criteria. With the comparison of pathological results used as the gold standard, pooled sensitivity (Sen) and specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (-LR), pooled diagnostic odds ratio (DOR) and the area under (AUC) of the summary receiver-operating characteristic curve (SROC) were:a) for diagnosing breast cancer, 0.69 (95%CI 0.60 to 0.76), 0.98 (95%CI 0.94 to 1.00), 10.75 (95%CI 4.10 to 28.16), 0.16 (95%CI 0.02 to 1.13), 56.76 (95%CI 17.50 to 184.14), 0.962 6; and b) axillary lymph node metastases, 0.63 (95%CI 0.59 to 0.66), 0.92 (95%CI 0.91 to 0.94), 6.01 (95%CI 4.07 to 8.89), 0.39 (95%CI 0.30 to 0.50), 17.35 (95%CI 10.58 to 28.46), 0.866 4. Conclusion18F-FDG PET/CT has a middle-degree sensitivity and relatively good specificity in diagnosing breast cancer and axillary lymph node metastases which can be regarded as an effective and feasible method for preoperative staging of breast cancer.
ObjectiveTo systematically review the diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer.MethodsWe electronically searched the databases including The Cochrane Library, PubMed, CNKI, WanFang Data, VIP, MedaLink and CBM for studies about diagnostic value of the ultrasonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then meta-analysis was performed using MetaDisc 1.4 software.ResultsA total of 9 studies involving 735 lymph nodes were included. The results of meta-analysis showed that, the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio and DOR were 0.82 (95%CI 0.78 to 0.86), 0.76 (95%CI 0.72 to 0.81), 3.32 (95%CI 2.57 to 4.27), 0.25 (95%CI 0.20 to 0.31), and 14.77 (95%CI 10.20 to 21.38), respectively. The AUC of the SROC curve was 0.8741.ConclusionUltrasonographic elastography has high sensitivity and specificity in the differential diagnosis of axillary lymph nodes in breast cancer, which indicates that it can be used to diagnosis axillary lymph nodes in breast cancer.
Objective To evaluate the diagnostic accuracy of Wilson score for predicating difficult intubation. Methods Such databases as PubMed, EMbase, CNKI, WanFang Data and VIP were searched to collect the studies about Wilson score for predicating difficult intubation published from inception to January 2013. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality by QUADAS. The analysis was conducted by using Meta-Disc 1.4 software, and the random effect model was chosen to calculate the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the 95%CI. The summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated in order to comprehensively assess the total diagnostic accuracy of Wilson score for predicating difficult intubation. Results A total of 9 studies involving 6 506 subjects were included. The results of meta-analysis showed that: the pooled sensitivity was 0.57 (95%CI 0.53 to 0.62), specificity was 0.89 (95%CI 0.88 to 0.90), positive likelihood ratio was 6.11 (95%CI 4.63 to 8.07), negative likelihood ratio was 0.52 (95%CI 0.41 to 0.66), diagnostic odds ratio was 12.76 (95%CI 8.60 to 18.93), and the AUC of SROC was 0.84. Conclusion Wilson score plays a role in predicating difficult intubation, while some other clinical indicators also need to be taken into consideration in its application.
Objectives To analyze and assess the status of detection of human immune-deficiency virus (HIV) by PCR, and to find a new screening test of HIV. Methods Using the following keywords "diagnosis tests", "AIDS", "PCR" and "HIV", we searched the Medline and CBM from 1991 to 2001. Then we assess each of diagnosis test according to the international standards. Results 567 articles were searched, in which 53 articles were chosen to assess. In these 53 articles, it was found that 47% applied comparison with Golden Standard, 25% calculated sensitivity, 23% calculated specificity, and 23% calculated predictive value, no likelihood ratio was calculated in these articles. Conclusions It was still a kind of pilot-study to apply PCR to screening detection of HIV. The design methods of study should be improved.