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Meta-Analysis
. 2019 May;98(18):e15450.
doi: 10.1097/MD.0000000000015450.

Pleural effusion as a substitute for tumor tissue in detecting EGFR/ALK mutations in non-small cell lung cancer: A systematic review and meta-analysis

Caishuang Pang  1 , Huiwen Ma  1 , Jiangyue Qin  2 , Sixiong Wang  1 , Chun Wan  2 , Ting Yang  2 , Yongchun Shen  2 , Donglin Wang  1
Affiliations
Meta-Analysis

Pleural effusion as a substitute for tumor tissue in detecting EGFR/ALK mutations in non-small cell lung cancer: A systematic review and meta-analysis

Caishuang Pang et al. Medicine (Baltimore). 2019 May.

Abstract

Background: Pleural effusion (PE) has been reported useful in many studies for testing epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) with variable results. This systematic review and meta-analysis was performed to elucidate whether PE could be used as a surrogate for tumor tissue to detect EGFR mutations.

Methods: We extracted 2 × 2 diagnostic table from each included study and calculated data on specificity, sensitivity, negative likelihood ratio (NLR), positive likelihood ratio (PLR) ,and diagnostic odds ratio (DOR). We used the area under curve (AUC) and summary receiver operating characteristic curve (SROC) to summarize the overall diagnostic performance and assessed publication bias by Deeks' funnel plot.

Results: Our meta-analysis included 15 eligible publications. The following summary estimates for diagnostic parameters of the EGFR mutations detection in PE were made: sensitivity, 0.86 (95%CI 0.83-0.89); specificity, 0.93 (95%CI 0.91-0.95); PLR, 8.53 (95%CI 5,94-12.25); NLR, 0.18 (95%CI 0.13-0.25); DOR, 63.40 (95%CI 38.83-103.51); and AUC, 0.94. Funnel plot indicated publication bias insignificant.

Conclusions: The meta-analysis suggests that EGFR mutation detecting in PE, especially supernatants, is a promising surrogate for tumor tissue in EGFR mutations testing of patients with NSCLC.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Studies selection process for the meta-analysis.
Figure 2
Figure 2
Summary of QUADAS-2 assessments of included studies. QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2.
Figure 3
Figure 3
Forest plot of the summary sensitivity and specificity of pleural effusion. The sensitivity/specificity of individual study is represented by a circle, through which runs a horizontal line (95% CI). The diamond at the bottom represents the pooled sensitivity/specificity from the studies. df = degrees of freedom.
Figure 4
Figure 4
Summary receiver operating characteristic (SROC) curve of pleural effusion. AUC = area under the curve.
Figure 5
Figure 5
Deeks's funnel plot to assess the likelihood of publication bias.
See this image and copyright information in PMC

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