The diagnostic value of confocal laser endomicroscopy for gastric cancer and precancerous lesions among Asian population: a system review and meta-analysis

Objective: The objective of this study is to evaluate the diagnostic value of confocal laser endomicroscopy (CLE) in detection of gastric cancer (GC), gastric intraepithelial metaplasia (GIM), and gastric intraepithelial neoplasia (GIN) lesions.

Method: PubMed, the Cochrane Library, and Wangfang databases were searched to include eligible articles about CLE in detection of gastric lesions. After study selection, quality assessment and data extraction conducted by two reviewers independently, meta-analysis was performed by Meta-Disc 1.4. The pooled sensitivity and specificity was calculated, receiver operating characteristic (ROC) curve was constructed, and the area under ROC curve (AUC) was calculated.

Results: Twenty-three studies evaluating the diagnostic value of CLE were included. For the diagnosis of GC lesions, the pooled sensitivity, specificity, and AUC were 91% (88–94%), 99% (99–99%), and 0.9513, respectively. For the diagnosis of lesions, the pooled sensitivity, specificity, and AUC were 92% (90–94%), 97% (96–98%), and 0.9774, respectively. For the diagnosis of GIN lesions, the pooled sensitivity, specificity and AUC were 81% (75–85%), 98% (97–98%), and 0.9204, respectively.

Conclusions: CLE can provide an accurate diagnosis with high sensitivity and specificity for GC, GIM, and GIN lesions. The results should be confirmed by well-designed, multi-centered, randomized controlled, and double blinded trials with large samples.     

Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: A meta-analysis

Background and objectiveEUS-FNA of pancreatic lesion has been put into clinical use widely in many centers. The present meta-analysis was conducted to study the diagnostic role of EUS-FNA in pancreatic cancer.MethodsA comprehensive review of study on the precision of EUS-FNA in the diagnosis of pancreatic cancer. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). A summary receiver-operating characteristic (SROC) was constructed to summarize the overall test performance.ResultsThirty-one articles were eligible for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS-FNA in the diagnosis of pancreatic cancer were 0.89 (95% CI: 0.88–0.90), 0.96 (95% CI: 0.95–0.97), 16.88 (95% CI: 10.63–26.79), 0.13 (95%CI: 0.10–0.16) and 150.80 (95%CI: 95.94–237.03) respectively. In subgroup meta-analysis of the prospective studies, the pooled sensitivity, specificity, PLR, NLR and DOR were 0.91 (95% CI: 0.90–0.93), 0.94 (95% CI: 0.91–0.96), 11.19 (95% CI: 6.36–19.69), 0.10 (95% CI: 0.07–0.15) and 125.22 (62.37–251.41). The area under the curve (AUC) was 0.97, indicating a good performance of overall accuracy.ConclusionEUS-FNA has the high sensitivity and specificity in differentiating pancreatic cancer. Moreover, it is also a safe diagnostic modality with little complications.     

Colonic lesion characterization in inflammatory bowel disease: A systematic review and meta-analysis

AIM To perform a systematic review and meta-analysis for the diagnostic accuracy of in vivo lesion characterization in colonic inflammatory bowel disease(IBD), using optical imaging techniques, including virtual chromoendoscopy(VCE), dye-based chromoendoscopy(DBC), magnification endoscopy and confocal laser endomicroscopy(CLE). METHODS We searched Medline, Embase and the Cochrane library. We performed a bivariate meta-analysis to calculate the pooled estimate sensitivities, specificities, positive and negative likelihood ratios(+LHR,-LHR), diagnostic odds ratios(DOR), and area under the SROC curve(AUSROC) for each technology group. A subgroup analysis was performed to investigate differences in real-time nonmagnified Kudo pit patterns(with VCE and DBC) and real-time CLE.RESULTS We included 22 studies [1491 patients; 4674 polyps, of which 539(11.5%) were neoplastic]. Real-time CLE had a pooled sensitivity of 91%(95%CI: 66%-98%), specificity of 97%(95%CI: 94%-98%), and an AUSROC of 0.98(95%CI: 0.97-0.99). Magnification endoscopy had a pooled sensitivity of 90%(95%CI: 77%-96%)and specificity of 87%(95%CI: 81%-91%). VCE had a pooled sensitivity of 86%(95%CI: 62%-95%) and specificity of 87%(95%CI: 72%-95%). DBC had a pooled sensitivity of 67%(95%CI: 44%-84%) and specificity of 86%(95%CI: 72%-94%). CONCLUSION Real-time CLE is a highly accurate technology for differentiating neoplastic from non-neoplastic lesions in patients with colonic IBD. However, most CLE studies were performed by single expert users within tertiary centres, potentially confounding these results.     

Age : pleural fluid ADA ratio and other indicators for differentiating between tubercular and malignant pleural effusions

Most of pleural effusions are caused by tuberculosis and malignant tumor. Difficult sampling and bacterial sparing nature of these diseases challenge doctors’ diagnosis in China.This study aimed to develop a new convenient and effective method for the differentiation of tuberculous and malignant pleural effusion.A prospective cohort study of patients hospitalized with malignant (n = 90) and tuberculous (n = 130) pleural effusions from September 2018 to October 2020 was performed. The diagnostic performance of the age to pleural fluid ADA ratio (age/ADA) and other indicators to distinguish tuberculous and malignant pleural effusions was evaluated by receiver operating characteristic (ROC) curve analysis.The areas under the curve (AUC) of age/ADA and pleural fluid ADA were largest. Age/ADA showed sensitivity and specificity of 81.5% (95%CI 73.8%–87.8%) and 97.8% (95%CI 92.2%–99.7%) respectively. The sensitivity and specificity of pleural fluid ADA were 83.1% (95%CI 75.5%–89.1%) and 93.3% (95%CI 86.1%–97.5%) respectively. The positive likelihood [36.69 (95%CI 9.3–144.8)] of age/ADA was significantly higher than that of pleural fluid ADA [12.46 (95%CI 5.7–27.1)]. The AUCs for Cancer Ratio and Cancer Ratio plus were lower and showed a sensitivity of 80.0% (95%CI 72.1%–86.5%), 80.0% (95%CI 70.2%–87.7%) and a specificity of 81.5% (95%CI 73.8%–87.8%), 80.0% (95%CI 70.2%–87.7%) respectively.Age/ADA has a higher diagnostic accuracy than ADA. Age/ADA is a promising diagnostic index for tuberculous and malignant pleural effusion with high sensitivity and specificity, especially the high positive likelihood ratio. The diagnostic accuracy of Cancer Ratio and Cancer Ratio plus are inferior to those of age/ADA and ADA.     

Diagnostic accuracy of D-Dimer testing for recurrent venous thromboembolism: A systematic review with meta-analysis.: VTE recurrence and D-dimer

ObjectiveVenous thromboembolism (VTE) recurrence is a major concern after a first symptomatic episode, potentially impacting survival and healthcare needs in community, hospital and rehabilitation settings. We evaluated the association of D-Dimer positivity after oral anticoagulant therapy (OAT) discontinuation with VTE recurrence.MethodsPubMed, 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 summary ROC (sROC) curve were calculated.ResultsTwenty-six articles on 10,725 VTE patients showed that the absolute risk of recurrence was 16.1% (95%CI: 13.2%-19.5%) among 4,049 patients with a positive D-Dimer and 7.4% (95%CI: 6.0%-9.0%) in 6,676 controls (OR: 2.1, 95%CI: 1.7-2.8, P<0.001), with an attributable risk of 54.0%. sROC curve of the association between positive D-Dimer and recurrence showed a diagnostic AUC of 63.8 (95%CI: 60.3-67.4), with a pooled sensitivity of 54.3% (95%CI: 51.3%-57.3%), specificity of 64.2% (95%CI: 63.2-65.1), PLR of 1.53 (95%CI: 1.37-1.72), and NLR of 0.71 (95%CI: 0.60-0.84). Subgroup and meta-regression analyses suggested that a positive D-Dimer may have a higher discriminatory ability for patients with provoked events, confirmed by better pooled diagnostic indexes for recurrence and a diagnostic AUC of 70.6 (95%CI: 63.8-77.4). Regression models showed that the rate of OAT resumption after the evidence of D-Dimer positivity was inversely associated with VTE recurrence (Z-score: -3.91, P<0.001).ConclusionsD-Dimer positivity after OAT may identify VTE patients at higher risk of recurrence, with a better diagnostic accuracy for provoked events.     

MRI versus CT for the detection of pulmonary nodules: A meta-analysis

Background:Computed tomography (CT) is the current gold standard for the detection of pulmonary nodules but has high radiation burden. In contrast, many radiologists tried to use magnetic resonance imaging (MRI) to replace CT because MRI has no radiation burden associated. Due to the lack of high-level evidence of comparison of the diagnostic accuracy of MRI versus CT for detecting pulmonary nodules, it is unknown whether CT can be replaced successfully by MRI. Therefore, the aim of this study was to compare the diagnostic accuracy of MRI versus CT for detecting pulmonary nodules.Methods:Electronic databases PubMed, EmBase, and Cochrane Library were systematically searched from their inception to September 2017 to identify studies in which CT/MRI was used to diagnose pulmonary nodules. According to true positive, true negative, false negative, and false positive extracted from the included studies, we calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) using Stata version 14.0 software (STATA Corp, TX).Results:A total of 8 studies involving a total of 653 individuals were included. The pooled sensitivity, specificity, PLR, NLR, and AUC were 0.91 (95% confidence interval [CI]: 0.80–0.96), 0.76 (95%CI: 0.58–0.87), 3.72 (95%CI: 2.05–6.76), 0.12 (95%CI: 0.06–0.27), and 0.91 (95%CI: 0.88–0.93) for MRI respectively, while the pooled sensitivity, specificity, PLR, NLR, and AUC for CT were 1.00 (95%CI: 0.95–1.00), 0.99 (95%CI: 0.78–1.00), 79.35 (95%CI: 3.68–1711.06), 0.00 (95%CI: 0.00–0.06), and 1.00 (95%CI: 0.99–1.00), respectively. Further, we compared the diagnostic accuracy of CT versus MRI and found that compared with MRI, CT shows statistically higher sensitivity (odds ratio [OR] for MRI vs CT: 0.91; 95%CI: 0.85–0.98; P value .010), specificity (OR: 0.82; 95%CI: 0.69–0.97; P value .019), PLR (OR: 0.29; 95%CI: 0.10–0.83; P value 0.02), AUC (OR: 0.91; 95%CI: 0.89–0.94; P value < .001), and lower NLR (OR: 8.72; 95%CI: 1.57–48.56; P value .013).Conclusion:Our study suggested both CT and MRI have a high diagnostic accuracy in diagnosing pulmonary nodules, while CT was superior to MRI in sensitivity, specificity, PLR, NLR, and AUC, indicating that in terms of the currently available evidence, MRI could not replace CT in diagnosing pulmonary nodules.     

Endoscopic retrograde cholangiopancreatography biliary tissue sampling

Confirming suspected pancreaticobiliary malignancy expedites treatment options. Narrowed ducts and periductular fibrosis may, however, limit tissue acquisition to achieve a definitive diagnosis. Based on clinical presentation, the pretest probability of malignancy often determines the approach and extent of evaluation. The least technically demanding technique that is safe, simple, and relatively inexpensive is brush cytology; however, when used alone, it often has an unacceptably low sensitivity. Endobiliary forceps biopsies have demonstrated higher rates for cancer detection but are more technically challenging. At the index procedure, multimodality sampling that involves combining at least 2 sampling techniques (typically brushings and biopsies) should be routinely performed, given a higher rate for detecting malignancy. For indeterminate biliary strictures, cholangioscopy visualization combined with directed biopsies, appears to significantly improve the diagnostic yield of endoscopic retrograde cholangiopancreatography sampling. However, although data are available suggesting superiority to brush cytology and conventional forceps biopsy, data from randomized controlled trials are lacking. Further, the role of advanced mucosal imaging and molecular studies continue to evolve.     

A meta-analysis of the diagnostic value of detecting K-ras mutation in pancreatic juice as a molecular marker for pancreatic cancer

BackgroundK-ras codon 12 mutation is one of the earliest genetic changes in the development of pancreatic cancer (PC) and accurate detection of K-ras mutations is gaining increasing attention in the field of molecular diagnosis.MethodsOriginal research articles which evaluated the diagnostic accuracy of K-ras mutation detection in PC were selected. Data were presented as forest plots and summary receiver operating characteristic curve analysis was used to summarize the overall test performance.ResultsWe assessed 16 studies from 15 published articles. The pooled sensitivity and specificity were 59% (95%CI: 54%–64%) and 87% (95%CI: 84%–89%), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.13 (95%CI: 2.73–6.25) and 0.42 (95%CI: 0.32–0.56), respectively, and the pooled diagnostic odds ratio was 13.66 (95% CI: 7.25–25.74).ConclusionsOur results indicate that the analysis of K-ras mutations in pancreatic juice has a considerable diagnostic value in PC. Further studies with rigorous design, large sample size, and multi-regional co-operation are needed.     

Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: A meta-analysis

Background and objectivesMucinous cystic neoplasms and intraductal papillary mucinous tumours have greater malignant potential than serous cystic neoplasms. EUS alone is inadequate for characterising these lesions but the addition of FNA may significantly improve diagnostic accuracy. The performance of EUS-FNA is highly variable in published studies.AimTo determine the diagnostic accuracy of EUS-FNA to differentiate mucinous versus non-mucinous cystic lesions with cyst fluid analysis for cytology and carcinoembryonic antigen (CEA) by performing a meta-analysis of published studies.MethodsRelevant studies were identified via structured database search and included if they used a reference standard of definitive surgical histology or clinical follow-up of at least 6 months. Data from selected studies were pooled to give summary sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio and Receiver Operating Characteristic (ROC) curve. Pre-defined subgroup analysis was performed.ResultsEighteen studies (published 2002–2011) were included, with a total of 1438 patients. For cytology, pooled sensitivity was 54(95%CI 49–59)% and specificity 93(90–95)%. The diagnostic odds ratio (DOR) was 13.3 (4.37–49.43), with I² of 77.1%. For CEA sensitivity was 63(59–67)% and specificity 88(83–91)%. The DOR was 10.76(6.29–18.41) with an I² of 25.4%. The diagnostic accuracy of EUS-FNA was enhanced in prospective studies and studies of <36 months duration. No impact of publication bias on our results was demonstrated.ConclusionsFine-needle aspiration has moderate sensitivity but high specificity for mucinous lesions. EUS-FNA, when used in conjunction with cross sectional imaging, is a useful diagnostic tool for the correct identification of mucinous cysts.     

Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough?

Background: Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians. Methods: Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI. Based on the coronary angiogram, a binary outcome of accurate versus inaccurate ECG interpretation was defined. We computed the overall sensitivity, specificity, accuracy and 95% confidence intervals (95%CIs) for ECG interpretation. Data on participant training level, working experience and place were collected. Results: 135 participants interpreted 4603 ECGs. Overall sensitivity to identify ‘true’ STEMI ECGs was 64.5% (95%CI: 62.8–66.3); specificity in determining ‘false’ ECGs was 78% (95%CI: 76–80.1). Overall accuracy was modest (69.1, 95%CI: 67.8–70.4). Higher accuracy in ECG interpretation was observed for attending physicians, participants working in tertiary care hospitals and those more experienced. Conclusion: The accuracy of interpretation of potential STEMI ECGs was modest among emergency physicians. The study supports the notion that ECG interpretation for establishing a STEMI diagnosis lacks the necessary sensitivity and specificity to be considered a reliable ‘stand-alone’ diagnostic test.     

Comparison of Quantitative Flow Ratio and Invasive Physiology Indices in a Diverse Population at a Tertiary United States Hospital

BackgroundQuantitative flow ratio (QFR) is a technology to evaluate the coronary stenosis significance on 3-dimensional quantitative coronary angiography. The aim of this study is to evaluate and compare the QFR versus fractional flow reserve (FFR) and/or instantaneous free-wave ratio (iFR) in a US population with a fair African American population representation.Methods and resultsThis was a retrospective, observational and single-center study that enrolled 100 patients who underwent coronary angiography. The diagnostic performance of QFR in terms of sensitivity was 0.80 (95%CI 0.64–0.97) and specificity was 0.95 (95% CI 0.90–1.00), the positive predictive value (PPV) was 0.83 (0.68–0.98), while the negative predictive value (NPV) was 0.94 (0.88–0.99). The overall accuracy was 0.91 and area under the curve (AUC) was 0.92 (95% CI 0.87–0.97).The R-squared was 0.54 and the Bland-Altman plot showed a bias of 0.0016 (SD 0.063) and limits of agreement (LOA): Upper LOA 0.13 and Lower LOA −0.12. In African Americans (n = 33), accuracy, AUC, sensitivity, specificity (94%; 0.90 [0.80–1.00]; 0.90 [0.71–1.00]; 0.96 [0.87–1.00], respectively) were better than those for the overall population.ConclusionsIn a US-based representative population, vessel QFR accuracy and agreement with FFR as reference is high. Diagnostic performance of QFR in African Americans is also excellent.     

Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings

AIM: To compare the interpretation of probe-based confocal laser endomicroscopy (pCLE) findings between endoscopists and gastrointestinal (GI)-pathologists.METHODS: All pCLE procedures were undertaken and the endoscopist rendered assessment. The same pCLE videos were then viewed offline by an expert GI pathologist. Histopathology was considered the gold standard for definitive diagnosis. The sensitivity, specificity and accuracy for diagnosis of dysplastic/ neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for pCLE findings were analyzed.RESULTS: Of the 66 included patients, 40 (60.6%) had lesions in the esophagus, 7 (10.6%) in the stomach, 15 (22.7%) in the biliary tract, 3 (4.5%) in the ampulla and 1 (1.5%) in the colon. The overall sensitivity, specificity and accuracy for diagnosing dysplastic/neoplastic lesions using pCLE were higher for endoscopists than pathologist at 87.0% vs 69.6%, 80.0% vs 40.0% and 84.8% vs 60.6% (P = 0.0003), respectively. Area under the ROC curve (AUC) was greater for endoscopists than the pathologist (0.83 vs 0.55, P = 0.0001). Overall agreement between endoscopists and pathologist was moderate for all GI lesions (K = 0.43; 95%CI: 0.26-0.61), luminal lesions (K = 0.40; 95%CI: 0.20-0.60) and those of dysplastic/neoplastic pathology (K = 0.55; 95%CI: 0.37-0.72), the agreement was poor for benign (K = 0.13; 95%CI: -0.097-0.36) and pancreaticobiliary lesions (K = 0.19; 95%CI: -0.26-0.63).CONCLUSION: There is a wide discrepancy in the interpretation of pCLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions. Further studies are needed to identify the cause of this poor agreement.     

Validity of Self-rating Screening Scales for the Diagnosis of Depression and Anxiety in Adult Patients With Bronchiectasis

BackgroundThere are no previous studies aimed at assessing the validity of the screening scales for depression and anxiety in adult patients with bronchiectasis.AimsTo analyze the psychometric properties of Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI) and Hamilton Anxiety Scale and to evaluate the concordance for the diagnosis of depression and anxiety between these screening scales and the structured clinical interview in adult patients with bronchiectasis.MethodCross sectional study. 52 patients with bronchiectasis completed HADS, BDI and Hamilton Anxiety Scale; afterwards, were individually interviewed by a mental health care professional using the structured Mini International Neuropsychiatric Interview (MINI), which evaluates for depression and anxiety according to DSM-IV criteria.ResultsBased on MINI, 18 subjects (34.6%) had a diagnosis of depression and 25 (48.1%) had anxiety. Optimal cut-off values to detect depression were ≥9 for the HADS-D (sensitivity 0.833, specificity 0.971, AUC 0.962 [95% CI 0.918–1]), and 17 for BDI (sensitivity 0.889, specificity 0.912, AUC 0.978 [95% CI 0.945–1]). Optimal cut-off values to detect anxiety were ≥4 for the HADS-A (sensitivity 0.960, specificity 0.593, AUC 0.833 [95% CI 0.723–0.943]), and 17 for Hamilton Anxiety Scale (sensitivity 0.800, specificity 0.852, AUC 0.876 [95% CI 0.781–0.970]).ConclusionThe self-rating screening scales HADS, BDI and Hamilton Anxiety Scale are reliable tools to screen for depression and anxiety in adult patients with bronchiectasis. However, the use of specific cut-off values may improve the diagnostic accuracy of the previous scales in this specific group of patients.     

Diagnostic utility of peroral cholangioscopy for various bile-duct lesions

BACKGROUND: We evaluated the utility of peroral cholangioscopy (POCS) for distinguishing malignant from benign biliary disease to cover low sensitivity of tissue sampling. METHODS: From February 1992 to April 2004, all consecutive patients who underwent POCS to confirm the etiology of biliary disorders were included in this study. Brushing cytology or endobiliary forceps biopsy also was performed. We analyzed the diagnostic accuracy of tissue sampling with or without POCS diagnosis. RESULTS: A total of 97 patients (66 men, 31 women; mean age 64.2 years) were included. The final diagnosis was confirmed by surgical resection in 44, clinical follow-up in 52, and cytologic study of ascitic fluid in one. On the basis of ERCP findings, there were 76 strictures and 21 filling defects. Forceps biopsy was performed in 25 patients, and brush cytology was performed in 68 patients. In the remaining 4 patients (4 filling defects, which were identified as stones by POCS), tissue samplings were not carried out. ERCP/tissue sampling correctly identified 22 of 38 malignant strictures and all 35 benign lesions except in 3 patients with inadequate samples (accuracy, 78.0%; sensitivity, 57.9%; specificity, 100%). The addition of POCS correctly identified all 38 malignant strictures and 33 of 38 benign lesions (accuracy, 93.4%; sensitivity, 100%; specificity, 86.8%). For the 21 filling defects observed by ERCP, POCS correctly diagnosed all 8 malignant diseases and 13 benign lesions. CONCLUSIONS: The addition of POCS to tissue sampling improves the diagnostic ability and covers for insufficient sensitivity. POCS is especially useful for diagnosing a filling defect.     

Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: A systematic review and meta-analysis

ObjectivesDifferential diagnosis of malignant and benign intraductal papillary mucinous neoplasms (IPMNs) is essential to determine the optimal treatment. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently used to diagnose pancreatic cystic lesions worldwide, but few studies have focused on the diagnostic yield to distinguish malignant and benign IPMNs. Therefore, we aim to systematically review the diagnostic yield of EUS-FNA-based cytology to distinguish malignant and benign IPMNs.MethodsRelevant studies with a reference standard of definitive surgical histology which published between 2002 and 2012 were identified via MEDLINE and SCOPUS. Malignant IPMNs included invasive adenocarcinoma, carcinoma in situ, and high-grade dysplasia.ResultsFour studies with 96 patients were included in this meta-analysis. For diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs, the pooled sensitivity and specificity were 64.8% (95% CI, 0.44–0.82) and 90.6% (95% CI, 0.81–0.96), respectively. Similarly, the positive likelihood ratio and negative likelihood ratio were 6.35 (95% CI, 2.95–13.68) and 0.43 (95% CI, 0.14–1.34), respectively. Malignant IPMNs were observed in 20.8% (20/96) of patients in EUS-FNA studies.ConclusionsEUS-FNA-based cytology has good specificity but poor sensitivity in differentiating benign from malignant IPMNs. Newer techniques or markers are needed to improve diagnostic yield.     

Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: A meta-analysis

Background/AimsEUS elastography is a novel technique that can be used for distinguishing benign from malignant lymph nodes and focal pancreatic masses. However, the studies pertaining to EUS elastography for differential diagnosis of solid pancreatic masses have reported widely varied sensitivities and specificities. A meta-analysis of all relevant articles was performed to estimate the overall diagnostic accuracy of EUS elastography for differentiating benign and malignant solid pancreatic masses.MethodsThe literatures were identified by searching in PubMed and Embase databases. Two reviewers independently extracted the information from the literatures for constructing 2 × 2 table. A random-effect model or a fixed-effect model was used to estimate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A summary receiver operating characteristic curve (SROC) also was constructed. Meta-regression and subgroup analysis were used to explore the sources of heterogeneity.Results13 studies including a total of 1042 patients with solid pancreatic masses were selected for meta-analysis. The pooled sensitivity and specificity of EUS elastography for differentiating benign and malignant solid pancreatic masses were 95% (95% confidence interval [CI], 93%–96%), 69% (95% CI, 63%–75%), respectively. The area under SROC (AUC) was 0.8695. Two significant variables were associated with heterogeneity: color pattern and blinding.ConclusionAs a less invasive modality, EUS elastography is a promising method for differentiating benign and malignant solid pancreatic masses with a high sensitivity, and it can prove to be a valuable supplement to EUS-FNA.     

Digital cholangioscopy: the diagnostic yield and impact on management of patients with biliary stricture

Abstract:

Objectives: Biliary strictures frequently present a diagnostic challenge. The aim of this study was to evaluate the impact of digital single-operator cholangioscopy (DSOC) on subsequent treatment of patients with biliary stricture.

Methods: Consecutive patients undergoing DSOC for biliary stricture were enrolled. Gold standard for final diagnosis included histology from surgical resection. In patients without surgery, clinical evaluation methods and repeated imaging studies were used for comparison of DSOC findings and final diagnosis. Patients were followed-up prospectively focusing on subsequent treatment.

Results: Among 30 enrolled patients, final diagnosis was malignant in 13 (43%) and benign in 17 (57%). The sensitivity and specificity of visual impression in diagnosing malignant stricture were 100% (95% CI: 75???100) and 76% (95% CI: 50???93), respectively. The sensitivity and specificity for biopsy were 92% (95% CI: 62???100) and 100% (95% CI: 78???100), respectively. One (3%) case of complicating cholangitis with fatal outcome occurred. Final treatment included surgery in 7 (23%), endoscopy in 18 (60%) and chemotherapy in 3 (10%) of patients.

Conclusions: In this study, favorable operating characteristics of DSOC were confirmed. Absolute negative predictive value of visual impression provided reassurance to patients with benign strictures who avoided unnecessary surgery in 53%. One (3%) case of cholangitis with fatal outcome occurred.     

Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography in patients with chronic inflammatory bowel disease: A systematic review and a meta-analysis

ObjectiveTo systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in patients with chronic inflammatory bowel disease (IBD).MethodsA comprehensive computer literature search of studies published through May 2012 regarding ¹⁸F-FDG-PET and PET/CT in patients with IBD was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR + and LR −) and diagnostic odd ratio (DOR) of ¹⁸F-FDG PET and PET/CT in patients with IBD on a per segment-based analysis were calculated. The area under the ROC curve was calculated to measure the accuracy of ¹⁸F-FDG PET and PET/CT in patients with IBD.ResultsNineteen studies comprising 454 patients with suspected IBD were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of seven selected studies (including 219 patients with IBD) provided the following results on a per segment-based analysis: sensitivity was 85% [95% confidence interval (95%CI) 81–88%], specificity 87% (95%CI 84–90%), LR + 6.19 (95%CI: 2.86–13.41), LR − 0.19 (95%CI: 0.10–0.34), and DOR 44.35 (95%CI: 11.77–167.07). The area under the ROC curve was 0.933.ConclusionsIn patients with suspected IBD ¹⁸F-FDG PET and PET/CT demonstrated good sensitivity and specificity, being accurate methods in this setting. Nevertheless, the literature focusing on the use of PET and PET/CT in IBD remains still limited; thus, further large multicenter studies will be necessary to substantiate the diagnostic accuracy of these methods in patients with IBD.     

Secretin-stimulated magnetic resonance imaging/magnetic resonance cholangiopancreatography for the detection of chronic pancreatitis: A meta-analysis

ObjectiveTo evaluate the diagnostic accuracy of secretin-stimulated magnetic resonance imaging/magnetic resonance cholangiopancreatography (S-MRI/MRCP) as noninvasive modalities in detecting chronic pancreatitis (CP).MethodsA systematic literature search in the PubMed, EMBASE, Web of Science, Cochrane, and Chinese Biomedical Literature Databases to identify relevant original studies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (version 2). Study data were independently extracted to calculate sensitivity and specificity, as well as areas under summary receiver operating characteristic curves (AUCs), and to test for heterogeneity and the threshold effect.ResultsThe sample comprised 11 studies including 180 patients with CP and 340 patients without CP. Pooled sensitivity and specificity were 0.72 (95% confidence interval [CI] 0.65–0.78) and 0.87 (95% CI 0.83–0.90), respectively. Pooled positive and negative likelihood ratios were 4.99 (95% CI 2.59–9.61) and 0.32 (95% CI 0.19–0.54), respectively. The diagnostic odds ratio was 23.31 (95% CI 7.50–72.44). The AUC and Q¹ index were 0.8631 and 0.7937, respectively. Publication bias was absent (P = 0.64).ConclusionsS-MRI/MRCP had low sensitivity and moderately high specificity for the detection of CP. Large-scale, quality-controlled, prospective studies are needed to verify the diagnostic accuracy of these modalities.     

Visceral adipose tissue is a better predictor than BMI in the alternative Fistula Risk Score in patients undergoing pancreatoduodenectomy

BackgroundMuscle attenuation (MA) and visceral adipose tissue (VAT) have not yet been included in the currently used alternative Fistula Risk Score (a-FRS). The aim of this study was to examine the added value of these parameters as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) in the a-FRS after pancreatoduodenectomy compared to Body Mass Index (BMI).MethodsA single center retrospective cohort study was performed in patients who underwent pancreatoduodenectomy between 2009 and 2018. The a-FRS model was reproduced, MA and VAT were both combined and separately added to the model instead of BMI using logistic regression analysis. Model discrimination was assessed by ROC-curves.ResultsIn total, 329 patients were included of which 55 (16.7%) developed CR-POPF. The a-FRS model showed an AUC of 0.74 (95%CI: 0.68–0.80). In this model, BMI was not significantly associated with CR-POPF (p = 0.16). The MA + VAT model showed an AUC of 0.81 (95%CI: 0.75–0.86). VAT was significantly associated with CR-POPF (per cm², OR: 1.01; 95%CI: 1.00–1.01; p < 0.001). The AUC of the MA + VAT model differed significantly from the AUC of the a-FRS model (p = 0.001).ConclusionVisceral adipose tissue is of added value in the a-FRS compared to BMI in predicting CR-POPF in patients undergoing pancreatoduodenectomy.