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Filis P, Alexiou GA, Zigouris A, Sioka C, Filis N, Voulgaris S. Meningioma grading based on positron emission tomography: A systematic review and meta-analysis. World Neurosurg X 2023; 18:100167. [PMID: 36825220 PMCID: PMC9941365 DOI: 10.1016/j.wnsx.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Meningiomas are the most common central nervous system tumor in adults. Knowledge of the tumor grade can guide optimal treatment timing and shape personalized follow-up strategies. Positron emission tomography (PET) has been utilized for the metabolic assessment of various intracranial space-occupying lesions. Herewith, we set out to evaluate the diagnostic accuracy of PET for the noninvasive assessment of meningioma's grade. Materials and methods The Medline, Scopus and Cochrane databases were systematically searched in March 2022 for studies that evaluated the sensitivity and specificity of PET compared to the gold standard of histological diagnosis in the grading of meningiomas. Summary statistics will be calculated and scatter plots, summary curve from the HSROC model and posterior predictions by empirical Bayes estimates will be presented. Results Five studies consisting of 242 patients with a total of 196 low-grade (Grade 1) and 46 high grade (Grade 2/3) meningiomas were included in our analysis. Three of the included studies used 18F-FDG, one study used 18F-FLT and one used(Whiting et al., 2011) 18 F-FET as PET tracers. The pooled sensitivity was 76% (95% CI: 52%-91%) and the pooled specificity was 89% (95% CI: 83%-93%). The diagnostic odds ratio was 27.17 (95% CI: 9.22-80.06), the positive likelihood ratio was 7.18 (95% CI: 4.54-11.34) and the negative likelihood ratio was 0.26 (95% CI: 0.11-0.61). Conclusion PET is a promising and viable option as a noninvasive imaging tool to differentiate the meningioma grades. However, currently it cannot overtake the gold standard of histological grade confirmation. More studies are required for further validation and refinement of this imaging technique and assessment of other radiotracers as well.
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Key Words
- 1/LR-, inverse of the negative likelihood ratio
- 11C-MET, 11C-methionine
- 18F-FDG, fluorine-18 fluorodeoxyglucose
- 18F-FET, O-(2-[18F]Fluoroethyl)-l-tyrosine
- CIs, 95% confidence intervals
- CT, computerized tomography
- DOR, diagnostic odds ratio
- HSROC, hierarchical summary receiver operating characteristic
- LR+, positive likelihood ratios
- LR−, negative likelihood ratios
- MRI, magnetic resonance imaging
- Mendingioma
- Meta-analysis
- PET
- PET, positron emission tomography
- SPECT, single-photon emission computerized tomography
- SUV, standardized uptake value
- SUVmax, maximum standardized uptake value
- TBR, tumour-to-brain ratios
- TGR, tumor-to-contralateral gray matter ratios
- WHO, World Health Organization
- [18F]FLT, 3′-deoxy-3′-[18F]fluorothymidine
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Affiliation(s)
- Panagiotis Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece,Corresponding author.
| | - Andreas Zigouris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, University of Ioannina, Greece
| | - Nikolaos Filis
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University of Ioannina, School of Medicine, Greece
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Stark MS, Klein K, Weide B, Haydu LE, Pflugfelder A, Tang YH, Palmer JM, Whiteman DC, Scolyer RA, Mann GJ, Thompson JF, Long GV, Barbour AP, Soyer HP, Garbe C, Herington A, Pollock PM, Hayward NK. The Prognostic and Predictive Value of Melanoma-related MicroRNAs Using Tissue and Serum: A MicroRNA Expression Analysis. EBioMedicine 2015; 2:671-80. [PMID: 26288839 PMCID: PMC4534690 DOI: 10.1016/j.ebiom.2015.05.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/09/2015] [Accepted: 05/09/2015] [Indexed: 01/08/2023] Open
Abstract
The overall 5-year survival for melanoma is 91%. However, if distant metastasis occurs (stage IV), cure rates are < 15%. Hence, melanoma detection in earlier stages (stages I–III) maximises the chances of patient survival. We measured the expression of a panel of 17 microRNAs (miRNAs) (MELmiR-17) in melanoma tissues (stage III; n = 76 and IV; n = 10) and serum samples (collected from controls with no melanoma, n = 130; and patients with melanoma (stages I/II, n = 86; III, n = 50; and IV, n = 119)) obtained from biobanks in Australia and Germany. In melanoma tissues, members of the ‘MELmiR-17’ panel were found to be predictors of stage, recurrence, and survival. Additionally, in a minimally-invasive blood test, a seven-miRNA panel (MELmiR-7) detected the presence of melanoma (relative to controls) with high sensitivity (93%) and specificity (≥ 82%) when ≥ 4 miRNAs were expressed. Moreover, the ‘MELmiR-7’ panel characterised overall survival of melanoma patients better than both serum LDH and S100B (delta log likelihood = 11, p < 0.001). This panel was found to be superior to currently used serological markers for melanoma progression, recurrence, and survival; and would be ideally suited to monitor tumour progression in patients diagnosed with early metastatic disease (stages IIIa–c/IV M1a–b) to detect relapse following surgical or adjuvant treatment. A seven-miRNA panel (MELmiR-7) detected the presence of melanoma with high sensitivity (93%) and specificity (≥ 82%). In serially collected stage IV specimens, members of the ‘MELmiR-7’ panel confirmed tumour progression in 100% of cases. The ‘MELmiR-7’ panel is superior to currently used serological markers for melanoma progression, recurrence, and survival.
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Key Words
- AGO2, argonaute RISC catalytic component 2
- AJCC, American Joint Committee on Cancer
- AUC, area under the curve
- AUROC, area under the receiver operator curve
- Biomarker
- CI, confidence interval
- Ct, threshold cycle
- DOR, diagnostic odds ratio
- Diagnostic
- FFPE, formalin-fixed paraffin-embedded
- HR, hazard ratio
- LDH, lactate dehydrogenase
- M1a, metastasis to skin, subcutaneous (below the skin) tissue, or lymph nodes in distant parts of the body, with a normal blood LDH level
- M1b, metastasis to the lungs, with a normal blood LDH level
- M1c, metastasis to any other organs, OR distant spread to any site along with an elevated blood LDH level
- MIA, Melanoma Institute of Australia
- Melanoma
- MiRNA
- MicroRNA
- N stage, nodal or number of lymph nodes stage
- NA, not applicable
- NM, nodular melanoma
- OR, odds ratio
- PD1, programmed cell death protein
- Prognostic
- RNA, ribonucleic acid
- S100B, S100 calcium-binding protein B
- SMM, superficial spreading melanoma
- USA, United States of America
- miR, microRNA
- miRNA, microRNA
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Affiliation(s)
- Mitchell S Stark
- Oncogenomics Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4029, Australia ; School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Kerenaftali Klein
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4029, Australia ; Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4029, Australia
| | - Benjamin Weide
- Department of Dermatology, University Medical Center, Tubingen, Germany
| | - Lauren E Haydu
- Melanoma Institute Australia, Sydney, NSW, Australia ; The University of Sydney, Sydney Medical School, Sydney, Australia
| | - Annette Pflugfelder
- Department of Dermatology, University Medical Center, Tubingen, Germany ; Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia
| | - Yue Hang Tang
- Surgical Oncology Group, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Jane M Palmer
- Oncogenomics Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4029, Australia
| | - David C Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4029, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia ; The University of Sydney, Sydney Medical School, Sydney, Australia
| | - Graham J Mann
- Melanoma Institute Australia, Sydney, NSW, Australia ; The University of Sydney, Sydney Medical School, Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia ; The University of Sydney, Sydney Medical School, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, Sydney, NSW, Australia ; The University of Sydney, Sydney Medical School, Sydney, Australia
| | - Andrew P Barbour
- Surgical Oncology Group, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia
| | - Claus Garbe
- Department of Dermatology, University Medical Center, Tubingen, Germany
| | - Adrian Herington
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Pamela M Pollock
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Nicholas K Hayward
- Oncogenomics Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD 4029, Australia
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Khuroo MS, Khuroo NS, Khuroo MS. Accuracy of Rapid Point-of-Care Diagnostic Tests for Hepatitis B Surface Antigen-A Systematic Review and Meta-analysis. J Clin Exp Hepatol 2014; 4:226-40. [PMID: 25755565 PMCID: PMC4284203 DOI: 10.1016/j.jceh.2014.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/25/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Rapid point-of-care tests provide plausible diagnostic strategy for hepatitis B surface antigen (HBsAg) in low resource areas. However, their utility depends upon their overall performance. Our objective was to meta-analyze the diagnostic accuracy of rapid point-of-care tests for HBsAg. METHODS Literature search was done with the help of a metasearch engine Mettā, a query interface for retrieving articles from five leading medical databases. Studies that employed rapid point-of-care tests for detection of HBsAg and compared the results with reference test were included. Two reviewers performed quality assessment of the studies and extracted data for estimating test accuracy. Twenty-seven studies were meta-analyzed and stratified by multiple parameters. RESULTS Twenty-seven studies had evaluated 49 test brands and generated 76 data points. Sensitivity of individual tests varied widely and were heterogeneous (range 43.5%-99.8%); while specificity estimates were more robust and close to 100% (range 90%-100%). Overall pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio for all tests were 97.1% (95% CI, 96.1%-97.9%), 99.9% (CI, 99.8%-100%), 118.4 (CI, 84.7-165.5), 0.032 (CI, 0.023-0.045) and 4094.7 (CI, 2504.1-6600.8) respectively. This suggested high pooled accuracy for all studies. We found substantial heterogeneity between studies. Three factors (study location, reference standard and study score) appeared most strongly associated with test estimates and observed heterogeneity. The Determine test showed consistency in performance in studies done across developed and developing countries and the Determine and the BinaxNOW tests had significantly higher estimates than pooled estimates of remaining tests. Tests revealed analytical sensitivity of 4 IU/ml against manufacturer's claim of 0.5 IU/ml; reduced sensitivity with HBsAg mutants and poor performance in seroconversion panels. CONCLUSIONS Tests with better analytical sensitivity need to be developed and their feasibility and outcomes in various clinical settings need to be addressed.
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Key Words
- DOR, diagnostic odds ratio
- EIA, enzyme immunoassay
- ELISA, enzyme-linked immunosorbent assay
- HBsAg
- HBsAg, hepatitis B surface antigen
- HSROC, hierarchical summary receiver operating characteristic
- LR, likelihood ratio
- MEIA, micro-particle enzyme immunoassay
- PCR, polymerase chain reaction
- PRISMA, preferred reporting items for systematic reviews and meta-analysis
- QUADAS, quality assessment of diagnostic accuracy of studies
- RPOCTs, rapid point-of-care tests
- SROC, summary receiver operating characteristic
- STARD, standard for reporting diagnostic accuracy studies
- meta-analysis
- performance evaluation
- rapid test
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Affiliation(s)
- Mehnaaz S. Khuroo
- Government Medical College Srinagar, Kashmir, Jammu & Kashmir 190010, India
| | - Naira S. Khuroo
- Digestive Diseases Centre, Dr Khuroo Medical Clinic, Srinagar, Kashmir, Jammu & Kashmir 190010, India
| | - Mohammad S. Khuroo
- Digestive Diseases Centre, Dr Khuroo Medical Clinic, Srinagar, Kashmir, Jammu & Kashmir 190010, India,Address for correspondence. Mohammad S. Khuroo, Director, Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, Jammu & Kashmir 190010, India. Tel.: +91 194 2491190, +91 9906591044 (mobile).
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