Diagnostic Performance of Shear Wave Elastography as Add-on Test in Thyroid Nodules: a Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: The diagnostic performance of shear wave elastography (SWE) combined with ultrasound (US) in the differential diagnosis of thyroid nodules was evaluated. MATERIALS AND METHODS: 459 articles were collected using KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. The searching words were ‘{(elastography and shear).mp. OR SWE.mp. OR acoustic radiation force impulse.mp. OR ARFI.mp. OR acuson.mp. OR aixplorer.mp.}’. Two authors independently performed article selection and evaluation of the quality of studies with Scottish Intercollegiate Guidelines Network tool. RESULTS: 2582 specimens (thyroid nodules) from 11 studies selected were included in this review. Combined use of US and SWE was reported higher specificity in five literatures, lower specificity in five studies, and no changes in 1 study when compared to US. We performed meta-analysis using data from 10 studies. The pooled sensitivity and specificity of US and SWE group for the differential diagnosis of benign and malignant nodules were 0.91 (I2=83.4%), 0.73 (I2=95.9%). The pooled sensitivity and specificity of US alone group were 0.88 (I2=93.2%), 0.71 (I2=92.7%). CONCLUSION: SWE is not effective in the differential diagnosis of thyroid nodules to minimize unnecessary biopsy of nodules. The included studies showed significant heterogeneity of results.

Diagnostic Effectiveness of PCR-based Tests Detecting BRAF Mutation for Treating Malignant Melanoma: A Systematic Review

BACKGROUND: We aimed to conduct a systematic review of previously published material to evaluate the diagnostic effectiveness of PCR-based tests in detecting BRAF mutation. METHODS: Eight Korean databases, including KoreaMed, Ovid-MEDLINE, and Ovid-EMBASE were used to identify relevant published studies. Nine studies describing usage of real-time PCR, dual-priming oligonucleotide (DPO)-multiplex real-time PCR and allele-specific PCR were included in the final assessment. Two reviewers screened all references independently for assessing the quality of the included articles and extracted data. RESULTS: The rate of detection of the BRAF mutations was lower in the Korean population (11.1-17.2%) than that in the Western population (36.7-82.2%). The diagnostic accuracy of the BRAF mutation tests was assessed on the basis of four previous reports, all of which employed real-time PCR on malignant melanoma. In fact, the diagnostic accuracy of real-time PCR was found to be higher than that of sequencing tests (pooled sensitivity, 0.96; pooled specificity, 0.83; and summary receiver operating characteristic area under the curve, 0.99). In addition, we found that there was no publication bias in meta-analysis. The concordance rate of the BRAF mutation tests compared with reference tests was 87.9-98.1%. CONCLUSIONS: Real-time PCR for the detection of the BRAF gene mutation is an effective technology for determining the appropriateness of treatment with BRAF kinase inhibitors in terminal stage cancer as well as metastatic and malignant melanoma.

Quality Dimension of Long Term Care Hospital

PURPOSE: This is a qualitative study to identify dimensions of long-term care hospital care quality that provide high-level medical services for long-term care patients in Korea. METHODS: Service consumers and providers were interviewed, and collected data were analyzed into thesis, type and dimension. The focus group method was applied to two provider groups and individual interview was applied to two persons who had experienced a long-term care hospital. RESULTS: The results of analyzing the comsumers and providers was integrated into 8 dimensions: physical environment, staff, clinical care and nursing, multiplicity of activity program, atmosphere, interaction with family, nutrition, and quality improvement system. CONCLUSION: The dimensions of long-term care hospital care quality from this study can be used as a basis of quality indicators. Quantitative studies to test these dimensions are required for establishing quality management systems.