Predictive value of radiologic studies for malignant otitis externa: a systematic review and meta-analysis.

OBJECTIVE: To determine the diagnostic accuracy of Necrotizing Otitis Externa (NOE) based on radiologic studies. METHODS: The PubMed, Cochrane, Embase, Web of Science, SCOPUS, and Google Scholar databases were searched. True-positive and false-negative results were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. RESULTS: The included studies contained data on 37 studies diagnosed with NOE. The sensitivity of gallium-67, technetium-99m, and Magnetic Resonance Imaging (MRI) was 0.9378 (0.7688-0.9856), 0.9699 (0.8839-0.9927), and 0.9417 (0.6968-0.9913), respectively. For Computed Tomography (CT), the positive criteria consisted of bony erosion alone and bony erosion plus any soft tissue abnormality. The sensitivity of CT based only on bony erosion was 0.7062 (0.5954-0.7971); it was higher 0.9572 (0.9000-0.9823) when based on bony erosion plus any soft tissue abnormality. CONCLUSION: The diagnostic sensitivity of technetium-99m, gallium-67, and MRI was favorable. On CT, the presence of bony erosion may be a useful diagnostic marker of NOE, but the diagnostic sensitivity will be even higher if the criterion of any soft tissue abnormality is also included; however, care should be taken when interpreting the results. Our study demonstrates the potential utility of radiology studies for diagnosing NOE, but their lack of specificity must be considered, and standardized anatomic criteria are still needed. LEVEL OF EVIDENCE: 2A.

Predictive value of radiologic studies for malignant otitis externa: a systematic review and meta-analysis

Abstract Objective: To determine the diagnostic accuracy of Necrotizing Otitis Externa (NOE) based on radiologic studies. Methods: The PubMed, Cochrane, Embase, Web of Science, SCOPUS, and Google Scholar databases were searched. True-positive and false-negative results were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: The included studies contained data on 37 studies diagnosed with NOE. The sensitivity of gallium-67, technetium-99m, and Magnetic Resonance Imaging (MRI) was 0.9378 (0.7688-0.9856), 0.9699 (0.8839-0.9927), and 0.9417 (0.6968-0.9913), respectively. For Computed Tomography (CT), the positive criteria consisted of bony erosion alone and bony erosion plus any soft tissue abnormality. The sensitivity of CT based only on bony erosion was 0.7062 (0.5954-0.7971); it was higher 0.9572 (0.9000-0.9823) when based on bony erosion plus any soft tissue abnormality. Conclusion: The diagnostic sensitivity of technetium-99m, gallium-67, and MRI was favorable. On CT, the presence of bony erosion may be a useful diagnostic marker of NOE, but the diagnostic sensitivity will be even higher if the criterion of any soft tissue abnormality is also included; however, care should be taken when interpreting the results. Our study demonstrates the potential utility of radiology studies for diagnosing NOE, but their lack of specificity must be considered, and standardized anatomic criteria are still needed. Level of evidence: 2A.

Efficacy of chemiluminescence in the diagnosis and screening of oral cancer and precancer: a systematic review and meta-analysis / Eficácia da quimioluminescência no diagnóstico e rastreamento de câncer oral e pré-câncer: uma revisão sistemática e metanálise

Abstract Introduction Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy. Objective This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions. Methods Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). Results Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692-0.917), 0.429 (95% CI 0.217-0.672), 0.747 (95% CI 0.607-0.849), and 4.061 (95% CI 1.528-10.796; I2 = 9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91). Conclusion Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.

Resumo Introdução A detecção precoce de distúrbios orais potencialmente malignos é fundamental para um bom prognóstico e não está claro se o uso da quimioluminescência como método auxiliar de triagem diagnóstica melhora a eficácia do diagnóstico. Objetivo Avaliar a precisão da quimioluminescência para o diagnóstico de câncer oral e pré-câncer. Método Foram revisados 16 estudos prospectivos e retrospectivos dos bancos de dados PubMed, Cochrane, Scopus, Web of Science, Embase e Google Scholar. Os distúrbios da mucosa oral detectados por quimioluminescência foram comparados com os distúrbios da mucosa oral detectados pelo azul de toluidina ou pelo exame visual. Taxas de resultados verdadeiro-positivos, verdadeiro-negativos, falso-positivos e falso-negativos foram extraídas de cada estudo. A qualidade metodológica foi avaliada com a ferramenta Quality Assessment of Diagnostic Accuracy Studies-versão 2 (QUADAS-2). Resultados Sensibilidade, especificidade, valor preditivo negativo e odds ratio diagnóstico do uso do azul de toluidina foram 0,832 (intervalo de confiança de 95%: 0,692-0,917), 0,429 (IC95%: 0,217-0,672), 0,747 (IC95%: 0,607-0,849) e 4,061 (intervalo de confiança 95%: 1,528-10,796; I2 = 9,128%), respectivamente. A área sob a curva SROC, do inglês summary receiver operating characteristic, foi de 0,743. Comparada ao azul de toluidina, como usado em 12 estudos, a quimioluminescência apresentou uma sensibilidade mais alta (0,831 vs. 0,694) e especificidade (0,415 vs. 0,734), valor preditivo negativo (0,674 vs. 0,729) e odds ratio diagnóstico (3,889 vs. 7,705) mais baixos. Comparado com o exame clínico, como usado em três estudos, a quimioluminescência apresentou menor odds ratio diagnóstico (4.576 vs. 5.499) e área sob a curva (0,818 vs. 0,91). Conclusão Embora a quimioluminescência em si tenha boa sensibilidade para o diagnóstico de câncer oral e pré-câncer, sua precisão diagnóstica é comparável ou pior do que o azul de toluidina e o exame clínico. A precisão do diagnóstico foi, portanto, insuficiente para o uso isolado confiável da quimioluminescência.

Efficacy of chemiluminescence in the diagnosis and screening of oral cancer and precancer: a systematic review and meta-analysis.

INTRODUCTION: Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy. OBJECTIVE: This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions. METHODS: Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). RESULTS: Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692-0.917), 0.429 (95% CI 0.217-0.672), 0.747 (95% CI 0.607-0.849), and 4.061 (95% CI 1.528-10.796; I2=9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91). CONCLUSION: Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.

A incidência de Helicobacter pylori em pacientes submetidos a gastrectomia para tratamento da úlcera péptica / The incidence of Helicobacter pylori

A úlcera péptica gastroduodenal tem etiologia multifatorial: hipersecreçäo gástrica, uso crônico de drogas, estresse e outros. Os conhecimantos sobre sua fisiopatologia foram revolucionados, nos últimos anos, pelas evidências da associaçäo da bactéria Helicobacter pylori (HP). Atualmente, admite-se que essa bactéria seja seu principal fator etiológico e que sua erradicaçäo muda a história natural da doença ulcerosa, promovendo até sua cura. A intervençäo cirúrgica até em alguns anos atrás era o trataemnto mais eficaz na úlcera péptica, mas atualmente, com a descoberta do Hp, a abordagem terapêutica consiste na eliminaçäo deste provável fator causal. O objetivo desta pesquisa é verificar a frequência e positividade do Hp em peças cirúrgicas de doentes submetidos a gastrectomia, quando ainda näo era empregado nem conhecido seu tratamento farmacológico. Assim, foram pesquisadas 70 lâminas histopatológicas feitas a partir das peças cirúrgicas dos pacientes submetidos a gastrectomia para tratamento de úlcera péptica. Dentre as lâminas analisadas a popsitividade para a bactéria foi de 53 casos (75,7 ppor cento), sendo 20, 28 e 5 entre os que apresentavam, respectivamente, úlcera gástrica (71,4 por cento), úlcera duodenal (75,7 por cento) e úlcera gástrica e duodenal concominantes (100 por cento). Concluem os autores que a incidência do Hp em portadores de úlcera péptica foi muito significativa e que essa bactéria deva ser considerada como um de seus fatores etiológicos. Além disso, provavelmente vários dos doentes desta casuística ppoderiam ter sido submetidos a trataemnto clínico para erradicaçäo da bactéria se tal tratamento fosse conhecido ou utilizado na época em quew foram operados. E, portanto, talvez terem sua cirurgia postergada ou näo realizada. é muito importante que no futuro novas pesquisas sejam realizadas, contribuindo para o melhor conhecimento da fisiopatologia da úlcer péptica