Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group

Jaeschke, Roman; Gh, Guyatt; Dl, Sackett

doi:10.1001/jama.271.9.703

Cited by 1,427 publications

(1,339 citation statements)

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“…As a result, LRÀ was significantly lower for TPO ICC (0.02) than either DPP4 (0.12) or HBME-1 (0.17). According to Jaeschke et al (1994), LRÀ values of less than 0.1 are highly significant, whereas values of 0.1 -0.2 are only moderately conclusive.…”

Section: Discussionmentioning

confidence: 96%

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Utility of malignancy markers in fine-needle aspiration cytology of thyroid nodules: comparison of Hector Battifora mesothelial antigen-1, thyroid peroxidase and dipeptidyl aminopeptidase IV

Micco¹,

Савченко²,

Giorgi

et al. 2008

Br J Cancer

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The purpose of this study was to compare the diagnostic interest of Hector Battifora mesothelial antigen-1 (HBME-1), thyroid peroxidase (TPO), and dipeptidyl aminopeptidase IV (DPP4) in thyroid fine-needle aspirates obtained from 200 resected thyroid lesions (55 colloid nodules, 54 follicular adenomas, 59 papillary cancers, and 32 follicular carcinomas). Hector Battifora mesothelial antigen-1 or TPO expression (% positive cells) and DPP4 staining score (12-point scale) were evaluated. Receiver operating characteristic (ROC) curves were plotted and optimal cutoff values for diagnosing malignancy were determined. The TPO ROC curve was consistently higher than the HBME-1 ROC curve. The TPO curve was also higher than the DPP4 curve with regard to sensitivity, but dipped below the DPP4 curve with regard to specificity. Using a cutoff value of o80% positive cells for TPO, 410% positive cells for HBME-1, and staining score X1 for DPP4, sensitivity to specificity ratios were 98 -83% for TPO, 90 -60% for HBME-1, and 88 -80% for DPP4. Two particularly interesting findings of this study were the low negative likelihood ratio of TPO (0.02) allowing highly reliable exclusion of malignancy and the 100% specificity of DPP4 staining scores ¼ 12. Due to poor performance on follicular lesions, HBME-1 showed no advantage over TPO or DPP4.

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Section: Discussionmentioning

confidence: 96%

“…We performed ROC analysis to compare the results and determine optimal cutoff values for diagnosis of malignancy (Hanley and McNeil, 1982). Positive and negative LR were calculated for a better estimation of the diagnostic value independent of the proportion of histological types of tumours in the series (Jaeschke et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

Utility of malignancy markers in fine-needle aspiration cytology of thyroid nodules: comparison of Hector Battifora mesothelial antigen-1, thyroid peroxidase and dipeptidyl aminopeptidase IV

Micco¹,

Савченко²,

Giorgi

et al. 2008

Br J Cancer

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“…Our study has an important finding with implications for those in clinical practice and the research community. The overall likelihood ratios of the existing criteria are reasonable but not to the level generally accepted as definitively diagnostic for positive or negative likelihood ratio (>10 and <0.1) 11. The overall sensitivity of all three criteria is poor—highlighting the clinical challenges in this area attempting to screen for disease earlier.…”

Section: Discussionmentioning

confidence: 88%

A prospective evaluation of the established criteria for heart failure with preserved ejection fraction using the Alberta HEART cohort

et al. 2017

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AimsHeart failure with a preserved ejection fraction (HF‐PEF) remains a difficult clinical diagnosis. The aim of this study was to test the utility of established criteria to classify patients with HF‐PEF. We prospectively enrolled patients into one of five groups across a spectrum of cardiac disease and applied three different criteria for HF‐PEF and calculated diagnostic metrics.Methods and resultsA total of 565 patients were included in the analysis, including 170 patients with an adjudicated diagnosis of HF‐PEF, 152 patients with heart failure with reduced ejection fraction, 152 patients at risk for heart failure, and 91 age‐matched healthy controls. For the diagnosis of HF‐PEF, the positive likelihood ratios were 6.1, 6.9, and 4.8 for the Zile, European Society of Cardiology (ESC) 2007, and ESC 2016 criteria, respectively. The negative likelihood ratios were 0.58, 0.60, and 0.42 for the Zile, ESC 2007, and ESC 2016 criteria, respectively. All three criteria lacked sensitivity to detect HF‐PEF (46.5%, 44.1%, and 51.8%, respectively) but were highly specific (92.4%, 93.9%, and 89%, respectively). We further evaluated the criteria to distinguish HF‐PEF from other diagnoses after excluding heart failure with reduced ejection fraction; the results were similar.ConclusionsIn this community based cohort, the likelihood ratios of the existing criteria for HF‐PEF were not at the level necessary to be considered diagnostic. Improved criteria for the diagnosis of patients with HF‐PEF are needed.

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“…Likelihood ratios < 0.1 or > 10 have been described as providing convincing diagnostic evidence, whereas those < 0.2 or > 5 give strong diagnostic evidence [29]. How ever, these guideline figures will not apply when pretest suspicions of the presence of the condition are very high or very low.…”

Section: Likelihood Ratiosmentioning

confidence: 99%

Defining laboratory reference values and decision limits: populations, intervals, and interpretations

Boyd¹

2010

Asian J Androl

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This article provides a brief overview of various approaches that may be utilized for the analysis of human semen test results. Reference intervals are the most widely used tool for the interpretation of clinical laboratory results. Reference interval development has classically relied on concepts elaborated by the International Federation of Clinical Chemistry Expert Panel on Reference Values during the 1980s. These guidelines involve obtaining and classifying samples from a healthy population of at least 120 individuals and then identifying the outermost 5% of observations to use in defining limits for two-sided or one-sided reference intervals. More recently, decision limits based on epidemiological outcome analysis have also been introduced to aid in test interpretation. The reference population must be carefully defined on the basis of the intended clinical use of the underlying test. To determine appropriate reference intervals for use in male ferti lity assessment, a reference population of men with documented time to pregnancy of < 12 months would be most suitable. However, for epidemiological assessment of semen testing results, a reference population made up of unselected healthy men would be preferred. Although reference and decision limits derived for individual semen analysis test results will undoubtedly be the interpretational tools of choice in the near future, in the long term, multivariate methods for the interpretation of semen analysis alone or in combination with information from the female partner seem to represent better means for assessing the likelihood of achieving a successful pregnancy in a subfertile couple.

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