Verification bias in diagnostic accuracy studies for fine‐ and core needle biopsy of salivary gland lesions in otolaryngology journals: A systematic review and analysis

Abstract

Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.

Verification and classification bias interactions in diagnostic test accuracy studies for fine‐needle aspiration biopsy

“…In general, partial verification bias occurs whenever the verification rate depends on the result of the index test. 2,3 Partial verification bias causes inaccurate estimates of both sensitivity and specificity. More specifically, partial verification bias generally causes overestimation of sensitivity and underestimation of specificity.…”

“…4 Partial verification is a common source of bias in DTA studies of FNAB. [3][4][5] Classification bias, the other common form of bias, occurs when the reference test is imperfect and results in misclassification of cases. Histopathology and clinical follow-up are the usual reference standards in DTA studies for FNAB.…”

“…5 A focused, systematic review found that 84% of FNAB DTA studies published in otolaryngology journals had partial verification bias. 3 Misclassification is also common in DTA studies. Misclassification rates are estimated by disagreement studies.…”

Comparison of Fine-Needle Aspiration and Core Needle Biopsy under Ultrasonographic Guidance for Detecting Malignancy and for the Tissue-Specific Diagnosis of Salivary Gland Tumors

“…[1][2][3][4][5][6][7] A recently published meta-analysis has suggested the influence of verification bias on the reported diagnostic accuracies of FNA, leading to an underestimation of its sensitivity and overestimation of its specificity in previous articles. 8 In addition to verification bias, differences in test conditions have a major effect on the diagnostic performance of FNA. These test conditions include the use of ultrasonography (US) guidance, the presence of a pathologist on site, the experience level of the operator and the pathologist, and the internal composition of the biopsied masses.…”

MRI criteria for the diagnosis of pleomorphic adenoma: a validation study

“…However, FNAB has limited diagnostic yield [5] and has even been shown to potentially misdirect surgical management [6]. The results of fine-needle aspiration cytology are not always conclusive because insufficient specimens are sometimes obtained because of a small sample size or because of the deep location of a tumor [7,8]. As such, there are a subset of patient for whom FNAB is either inconclusive or less than ideal as a primary modality for evaluation of parotid tumors.…”