Esophageal Endosonography for the Diagnosis of Intrapulmonary Tumors:A Systematic Review and Meta-Analysis

BACKGROUND: Biopsy-based diagnosis in patients with paraesophageal intrapulmonary tumors suspected of lung cancer is crucial for adequate treatment planning. OBJECTIVE: To evaluate the performance of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the diagnosis of intrapulmonary tumors located near or adjacent to the esophagus. METHODS: We performed a systematic review (PROSPERO, CRD42016033737) and searched MEDLINE, Embase, BIOSIS Previews, and Web of Science on September 22, 2016, without date or language restrictions. We included studies that evaluated the yield and/or sensitivity of EUS-FNA for diagnosing intrapulmonary tumors. Yield was defined as the number of patients in whom EUS-FNA made a biopsy-proven diagnosis (malignant or nonmalignant) relative to the total number of patients on whom EUS-FNA was performed. Sensitivity was defined as the number of patients in whom EUS-FNA made a biopsy-proven diagnosis of malignancy relative to the total number of patients in whom the tumor was found to be malignant. We performed a random-effects meta-analysis. RESULTS: Of 3,320 search results, 11 studies were included. Ten had a high risk of bias. The total number of patients was 313; the proportion of patients with malignancy ranged from 87 to 100% across these studies. The average yield was 0.90 (95% CI 0.82-0.95) and the average sensitivity was 0.92 (0.83-0.96). In the subgroup of prospective studies (n = 3), the average yield was 0.80 (0.56-0.93) and the average sensitivity was 0.83 (0.58-0.95). EUS-FNA-induced complications were reported for 5/256 patients (2.0%) for whom this information was available. CONCLUSIONS: Although the number of high-quality studies is limited, these findings suggest that EUS-FNA is safe and has a high yield for diagnosing intrapulmonary tumors

Five-Year Survival After Endosonography vs Mediastinoscopy for Mediastinal Nodal Staging of Lung Cancer.

Lung cancer accounts for the highest cancer-related mortality rate worldwide.1 Accurate mediastinal nodal staging is crucial in the management of non–small cell lung cancer (NSCLC) because it directs therapy and has prognostic value.2,

Endobronchial ultrasound in diagnosing and staging of lung cancer by Acquire 22G TBNB versus regular 22G TBNA needles:A randomized clinical trial

Objectives: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has an important role in the diagnosis and staging of lung cancer. Evaluation of programmed death ligand 1 (PD-L1) expression and molecular profiling has become standard of care but cytological samples frequently contain insufficient tumor cells. The 22G Acquire needle with Franseen needle tip was developed to perform transbronchial needle biopsy (TBNB) with improved tissue specimens. This study evaluated if the 22G Acquire TBNB needle results in enhanced PD-L1 suitability rate compared to the regular Expect 22G TBNA needle. Methods:In this multi-center randomized clinical trial (Netherlands Trial Register NL7701), patients with suspected (N)SCLC and an indication for mediastinal/hilar staging or lung tumor diagnosis were recruited in five university and general hospitals in the Netherlands, Poland, Italy and Czech Republic. Patients were randomized (1:1) between the two needles. Two blinded reference pathologists evaluated the samples. The primary outcome was PD-L1 suitability rate in patients with a final diagnosis of lung cancer. In case no malignancy was diagnosed, the reference standard was surgical verification or 6 month follow-up. Results: 154 patients were randomized (n = 76 Acquire TBNB; n = 78 Expect TBNA) of which 92.9% (n = 143) had a final malignant diagnosis. Suitability for PD-L1 analysis was 80.0% (n = 56/70; 95 %CI 0.68–0.94) with the Acquire needle and 76.7% (n = 56/73; 95 %CI 0.65–0.85) with the Expect needle (p = 0.633). Acquire TBNB needle specimens provided more frequent superior quality (65.3% (95 %CI 0.57–0.73) vs 49.4% (95 %CI 0.41–0.57, p = 0.005) and contained more tissue cores (72.0% (95 %CI 0.60-0.81) vs 41.0% (95 %CI 0.31–0.54, p &lt; 0.01). There were no statistically significant differences in tissue adequacy, suitability for molecular analysis and sensitivity for malignancy and N2/N3 disease. Conclusion: The 22G Acquire TBNB needle procured improved quality tissue specimens compared to the Expect TBNA needle but this did not result in an improved the suitability rate for PD-L1 analysis.</p

Nonnegative rank-preserving operators

AbstractAnalogues of characterizations of rank-preserving operators on field-valued matrices are determined for matrices witheentries in certain structures S contained in the nonnegative reals. For example, if S is the set of nonnegative members of a real unique factorization domain (e.g. the nonnegative reals or the nonnegative integers), M is the set of m×n matrices with entries in S, and min(m,n)⩾4, then a “linear” operator on M preserves the “rank” of each matrix in M if and only if it preserves the ranks of those matrices in M of ranks 1, 2, and 4. Notions of rank and linearity are defined analogously to the field-valued concepts. Other characterizations of rank-preserving operators for matrices over these and other structures S are also given

Preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts):checklist, explanation, and elaboration

For many users of the biomedical literature, abstracts may be the only source of information about a study. Hence, abstracts should allow readers to evaluate the objectives, key design features, and main results of the study. Several evaluations have shown deficiencies in the reporting of journal and conference abstracts across study designs and research fields, including systematic reviews of diagnostic test accuracy studies. Incomplete reporting compromises the value of research to key stakeholders. The authors of this article have developed a 12 item checklist of preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts). This article presents the checklist, examples of complete reporting, and explanations for each item of PRISMA-DTA for Abstracts

STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies.

Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a diagnostic accuracy study. This update incorporates recent evidence about sources of bias and variability in diagnostic accuracy and is intended to facilitate the use of STARD. As such, STARD 2015 may help to improve completeness and transparency in reporting of diagnostic accuracy studies

Het gevaar van ongepubliceerde onderzoeksresultaten

Unpublished and selectively published trial results may lead to distortion of the effectiveness and the profile of side effects of interventions. This jeopardizes patient safety and leads to unnecessary costs. Between 25 and 50% of all clinical trials remain unpublished. Primary outcomes, as originally defined in study protocols, often differ from those in the final publication. Positive trial results are almost 3 times as likely to be published as negative results. Commercial sponsorship is strongly associated with the publication of results that promote the interests of that sponsor, but non-publication and selective reporting is also frequent among non-commercial trials. Existing solutions, such as the requirement for prospective registration of trial protocols and the mandatory publication of trial results within 1 year after completion of the trial will only be successful if their compliance is more strictly monitore

Infrequent and incomplete registration of test accuracy studies: analysis of recent study reports

Objectives: To identify the proportion of articles reporting on test accuracy for which the corresponding study had been registered. Design: Analysis of a consecutive sample of published study reports. Participants: PubMed was searched for publications in journals with an impact factor of 5 or higher in May and June 2012. Articles were included if they reported on original studies evaluating the accuracy of one or more diagnostic or prognostic tests or markers against a clinical reference standard in humans. Primary and secondary outcome measures: Primary outcome was registration of the reported test accuracy study. We additionally explored study characteristics associated with registration. Results: We found 1941 references; 351 study reports fulfilled the inclusion criteria, of which 52 studies (15%) had been registered. Of these, 27 (52%) provided a registration number in the publication, and 12 (23%) provided a reference to the publication in the registry. Registration rates were similar for studies on diagnostic versus those on prognostic tests, and among studies on imaging tests versus those on laboratory techniques. Studies reporting some form of industry involvement were more often registered (33%) than studies reporting another source of funding (11%), and studies without a (reported) source of (external) funding (9%; p <0.001). Of the registered studies, 8 (15%) had been registered after completion, 14 were registered before initiation (27%) and 30 (58%) between initiation and completion. Only 16 (31%; 5% of the total sample) had registered the published primary outcome measures before completion. Conclusions: Few test accuracy studies published in higher impact journals are registered. Only 1 in 22 of such studies register their primary outcomes before study completion. Owing to the reasons for registering studies that investigate the cause-and-effect relationship between health-related interventions and health outcomes also apply to test accuracy studies, prospective study registration of these studies should be further promoted among investigators and journal editor