Graphical enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta‐analysis of diagnostic test accuracy data

Patel, Amit N.; Cooper, Nicola J.; Freeman, Suzanne C.; Sutton, Alex J.

doi:10.1002/jrsm.1439

Cited by 97 publications

(63 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, our AUC analysis estimated the overall diagnostic performance of biomarkers compared with their pooled sensitivity and specificity. We generated an SROC plot by weighting each study based on samples that can further enhance SROC to facilitate reporting (96,97). The AUC of weighted SROC curves for the HER2-enriched subtype was higher than those of the other biomarkers assessed.…”

Section: Discussionmentioning

confidence: 99%

Comparing Biomarkers for Predicting Pathological Responses to Neoadjuvant Therapy in HER2-Positive Breast Cancer: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

IntroductionThe predictive strength and accuracy of some biomarkers for the pathological complete response (pCR) to neoadjuvant therapy for HER2-positive breast cancer remain unclear. This study aimed to compare the accuracy of the HER2-enriched subtype and the presence of PIK3CA mutations, namely, TILs, HRs, and Ki-67, in predicting the pCR to HER2-positive breast cancer therapy.MethodsWe screened studies that included pCR predicted by one of the following biomarkers: the HER2-enriched subtype and the presence of PIK3CA mutations, TILs, HRs, or Ki-67. We then calculated the pooled sensitivity, specificity, positive and negative predictive values (PPVs and NPVs, respectively), and positive and negative likelihood ratios (LRs). Summary receiver operating characteristic (SROC) curves and areas under the curve (AUCs) were used to estimate the diagnostic accuracy.ResultsThe pooled estimates of sensitivity and specificity for the HER2-enriched subtype and the presence of PIK3CA mutations, namely, TILs, HRs, and Ki-67, were 0.66 and 0.62, 0.85 and 0.27, 0.49 and 0.61, 0.54 and 0.64, and 0.68 and 0.51, respectively. The AUC of the HER2-enriched subtype was significantly higher (0.71) than those for the presence of TILs (0.59, p = 0.003), HRs (0.65, p = 0.003), and Ki-67 (0.62, p = 0.005). The AUC of the HER2-enriched subtype had a tendency to be higher than that of the presence of PIK3CA mutations (0.58, p = 0.220). Moreover, it had relatively high PPV (0.58) and LR+ (1.77), similar NPV (0.73), and low LR− (0.54) compared with the other four biomarkers.ConclusionsThe HER2-enriched subtype has a moderate breast cancer diagnostic accuracy, which is better than those of the presence of PIK3CA mutations, TILs, HRs, and Ki-67.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparing Biomarkers for Predicting Pathological Responses to Neoadjuvant Therapy in HER2-Positive Breast Cancer: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The data retrieved from the selected studies were included into the RevMan 5.4 software for MacOS systems. We then calculated HSROC and bivariate model parameters to calculate pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios with the MetaDTA software [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Method Applied to Focused Ultrasound: The Case of Wells’ Score and Echocardiography in the Emergency Department: A Systematic Review and a Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: bedside cardiac ultrasound is a widely adopted method in Emergency Departments (ED) for extending physical examination and refining clinical diagnosis. However, in the setting of hemodynamically-stable pulmonary embolism, the diagnostic role of echocardiography is still the subject of debate. In light of its high specificity and low sensitivity, some authors suggest that echocardiographic signs of right ventricle overload could be used to rule-in pulmonary embolism. In this study, we aimed to clarify the diagnostic role of echocardiographic signs of right ventricle overload in the setting of hemodynamically-stable pulmonary embolism in the ED. Materials and Methods: we performed a systematic review of literature in PubMed, Web of Science and Cochrane databases, considering the echocardiographic signs for the diagnosis of pulmonary embolism in the ED. Studies considering unstable or shocked patients were excluded. Papers enrolling hemodynamically stable subjects were selected. We performed a diagnostic test accuracy meta-analysis for each sign, and then performed a critical evaluation according to pretest probability, assessed with Wells’ score for pulmonary embolism. Results: 10 studies were finally included. We observed a good specificity and a low sensitivity of each echocardiographic sign of right ventricle overload. However, once stratified by the Wells’ score, the post-test probability only increased among high-risk patients. Conclusions: signs of echocardiographic right ventricle overload should not be used to modify the clinical behavior in low- and intermediate- risk patients according to Wells’ score classification. Among high-risk patients, however, echocardiographic signs could help a physician in detecting patients with the highest probability of pulmonary embolism, necessitating a confirmation by computed tomography with pulmonary angiography. However, a focused cardiac and thoracic ultrasound investigation is useful for the differential diagnosis of dyspnea and chest pain in the ED.

show abstract

“…Statistical analyses were performed using Comprehensive Meta-analysis (Version 2, Biostat, Englewood NJ, 2005), Review Manager software (Version 5.4.1, The Cochrane Collaboration, Copenhagen, Denmark), R Statistical software (R Core Team 2021) and MetaDTA (Version 2.0) [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background. Chronic cough is a disabling condition with a high proportion of diagnostic and therapeutic failures. Fractional exhaled nitric oxide (FeNO) has been considered a useful biomarker for predicting inhaled corticosteroids (ICS) response. We evaluated the relationship between FeNO and ICS response in chronic cough by performing a systematic review with meta-analysis. Methods. PubMed, Web of Science, Scopus and EMBASE databases were systematically searched. Differences were expressed as Odds Ratio (OR) with 95% confidence intervals (95%CI). Pooled sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and area under the hierarchical summary receiver operating characteristic curve (HSROC AUC ) were estimated. Results. Nine articles on 740 chronic-cough patients showed that the response rate to ICS was 87.4% (95%CI: 83.8–91.0) in 317 patients with a high FeNO and 46.3% (95%CI: 41.6–51.0) in 423 controls, with an attributable proportion of 47.0% and a diagnostic OR of 9.1 (95%CI: 3.7–22.4, p < .001). The pooled estimate of diagnostic indexes resulted in a sensitivity of 68.5% (95%CI: 46.7–84.4) and specificity of 81.9% (95%CI: 63.0–92.3), with a HSROC AUC of 0.82 (95%CI: 0.64–0.90). In a realistic scenario with a pre-test probability set at 30%, based on a pooled PLR of 3.79 (95%CI: 1.24–7.47) and NLR of 0.38 (95%CI: 0.22–0.66), the post-test probability was 62% with a high FeNO and 14% if the test was negative. Subgroup analyses confirmed a better performance for the recommended FeNO cut-off greater than 25 ppb. Meta-regression and sensitivity analyses showed no impact of major demographic and clinic variables on results. Conclusions. A high FeNO before starting ICS therapy may help identify chronic-cough patients responding to treatment, with a better performance ofhigher cut-off values. Further studies are needed to evaluate the real usefulness of this biomarker to guide cough therapy and optimise strategies in different healthcare settings (community, hospital, rehabilitation). Key messages Chronic cough is a disabling condition with a high proportion of diagnostic and therapeutic failures. Fractional exhaled nitric oxide (FeNO) may be a useful biomarker for identifying chronic cough patients who respond to steroid treatment. A FeNO cut-off lower than 25 ppb should be considered irrelevant for this clinical application.

show abstract

Graphical enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta‐analysis of diagnostic test accuracy data

Abstract: enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta-analysis of diagnostic test accuracy data.

Cited by 97 publications

References 20 publications

Comparing Biomarkers for Predicting Pathological Responses to Neoadjuvant Therapy in HER2-Positive Breast Cancer: A Systematic Review and Meta-Analysis

Comparing Biomarkers for Predicting Pathological Responses to Neoadjuvant Therapy in HER2-Positive Breast Cancer: A Systematic Review and Meta-Analysis

Clinical Method Applied to Focused Ultrasound: The Case of Wells’ Score and Echocardiography in the Emergency Department: A Systematic Review and a Meta-Analysis

Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis

Contact Info

Product

Resources

About