REPORT CRITICAL APPRAISAL OF DIAGNOSTIC

Nama : Ditha MarissyaDaud

NIM : 12/335343/KU/15156
Grup/Kelompok : B/9



DIAGNOSIS WORKSHEET

Citation :
Fan, Zhihui, Li, Ying, Yan, Kun, Wu, Wei, Yin, Shanshan, Yang, Wei, Xing, Baocai, Li, Xiaoting,
Zhang, Xiaopeng 2013, Application of Contrast-Enhanced Ultrasound in The Diagnosis of Solid
Pancreatic Lesions-A Comparison of Conventional Ultrasound and Contrast-Enhanced CT,
European Journal of Radiology.

Are the results of this diagnostic study valid?

Was there an independent, blind
comparison with a reference standard of
diagnosis?
Ada, masing-masing CEUS dan CECT
dibandingkan conventional US sebagai gold
standard. US merupakan metode imaging
yang dipilih untuk screening lesi pancreas.
CEUS sebagai terapi baru yang ingin diuji
dibandingkan dengan US; dan juga selain itu
CEUS dibandingkan pula dengan CECT,
terapi yang beberapa tahun belakangan
sering dipakai untuk mendiagnosis karena
sensitivitas dan spesifisitasnya tinggi serta
mampu medeteksi staging lesi pancreas
untuk membandingkan akurasi CEUS
dengan CECT.
Was the diagnostic test evaluated in an
appropriate spectrum of patients (like
those in whom it would be used in
practice)?
Diagnostic test dilakukan pada 90 pasien
dengan lesi focal pancreas padat, terdiri dari
58 pasien yang sudah melakukan surgical
pathology, 12 pasien yang sudah melakukan
biopsi, dan 20 pasien mendapatkan
comprehensive clinical diagnosis.
Was the reference standard applied
regardless of the diagnostic test result?
Standard tetap diaplikasikan karena standard
yang dipakai merupakan hasil keputusan
consensus dari 3 orang ultrasound physician.

Was the test (or cluster of tests) validated
in a second, independent group of
patients?
Tidak ada.










Are the valid results of diagnostic study important?

CALCULATIONS

1. CEUS dibandingkan dengan US Pada Pancreatic Carcinoma (Salah Satu Kasus Lesi
Pancreas)




US (Gold Standard)

Totals
Positive

Negative
C
E
U
S
Positive

33 7 40
Negative 3 47 50
Totals


36 54 90
a. Sensitivity= a/(a+c) = 91.67%
b. Specificity= d/(b+d) = 87.03%
c. Likelihood ratio for a positive test result = sensitivity/(1-specificity)
= 91.67%/12.97%
= 7.23
d. Likelihood ratio for a negative test result = (1-sensitivity)/specificity
= 8.33/87.03
= 0.095
e. Positive predictive value = a/(a+b)
= 33/40
= 82.5%
f. Negative predictive value = d/(c+d)
= 94%
g. Pre-test probability (prevalence) = (a+c)/(a+b+c+d)
= 40%
h. Pre-test odds = Prevalance/(1-prevalance)
= 0.67
i. Post-test odds = (pre-test odds) x LR (+)
= 4.84
j. Post-test odds = (pre-test odds) x LR (-)
= 0.064
k. Post-test probability (LR+) = (post-test odds)/(post-test odds+1)
= 0.828
l. Post-test probability (LR-) = (post-test odds)/(post-test odds+1)
= 0.06

2. CECT dibandingkan dengan US




US (Gold Standard)

Totals
Positive

Negative
C
E
C
T
Positive

35 6 41
Negative 1 48 49
Totals

36 54 90

a. Sensitivity= a/(a+c) = 97.2%
b. Specificity= d/(b+d) = 88.9%
c. Likelihood ratio for a positive test result = sensitivity/(1-specificity)
= 97.2%/11.1%
= 8.76
d. Likelihood ratio for a negative test result = (1-sensitivity)/specificity
= 2.8/88.9
= 0.03
e. Positive predictive value = a/(a+b)
= 35/41
= 85.36%
f. Negative predictive value = d/(c+d)
= 97.96%
g. Pre-test probability (prevalence) = (a+c)/(a+b+c+d)
= 40%
h. Pre-test odds = Prevalance/(1-prevalance)
= 0.67
i. Post-test odds = (pre-test odds) x LR (+)
= 5.87
j. Post-test odds = (pre-test odds) x LR (-)
= 0.0201
k. Post-test probability (LR+) = (post-test odds)/(post-test odds+1)
= 0.828
l. Post-test probability (LR-) = (post-test odds)/(post-test odds+1)
= 0.019

Berdasarkan hasil penelitian, akurasi diagnosis CEUS lebih baik dari gold standard
(conventional US) dan memiliki performa yang nyaris sama dengan CECT.


Can You apply this valid, important evidence about a diagnostic test in caring for your
patient?

Is the diagnostic test available, affordable,
accurate, and precise in your setting?
-
Can You generate a clinically sensible
estimate of your patientss pre-test
probability (from personal experience,
prevalence statistics, practice statistics,
practice database, or primary studies)?
Are the study patients similar to your
own?
Is it unlikely that the disease
possibilities or probabilities have
changed since the evidence was
gathered?
-
Will the resulting post-test probabilities
affect your management and help your
patient?
Could it move you across a test-
treatment threshold?
Would your patient be a willing
partner in carrying it out?
-
Would the consequences of the test help
your patient?
-