Findings with the pleural nodularity via thoracic ultrasound using the Grading of Recommendations, Assessment, Development and Evaluation approach
| Question | Should pleural nodularity via thoracic ultrasound be used in diagnosing malignant pleural effusion in patients with pleural effusion who are suspected to have malignancy? | ||||||||||
| Sensitivity | 0.42 (95% CI 0.25–0.62) | Prevalence | 10% | 20% | 40% | ||||||
| Specificity | 0.97 (95% CI 0.93–0.99) | ||||||||||
| Outcome | No. studies (no. patients) | Study design | Factors that may decrease certainty of evidence | Effect per 1000 patients tested | Test accuracy CoE | ||||||
| Risk of bias | Indirectness | Inconsistency | Imprecision | Publication bias | Pre-test probability of 10% | Pre-test probability of 20% | Pre-test probability of 40% | ||||
| True positives (patients with MPE) | Four studies (459 patients) | Cohort and case–control type studies | Serious# | Not serious | Not serious | Not serious | None | 43 (25–62) | 85 (51–123) | 170 (101–246) | ⨷⨷⨷○ moderate |
| False negatives (patients incorrectly classified as not having MPE) | 57 (38–75) | 115 (77–149) | 230 (154–299) | ||||||||
| True negatives (patients without MPE) | Four studies (545 patients) | Cohort and case–control type studies | Serious# | Not serious | Not serious | Not serious | None | 872 (839–887) | 775 (746–789) | 581 (559–592) | ⨷⨷⨷○ moderate |
| False positives (patients incorrectly classified as having MPE) | 28 (13–61) | 25 (11–54) | 19 (8–41) | ||||||||
MPE: malignant pleural effusion; CoE: certainty of evidence. #: In all the included studies, it was unclear whether the pathologists were aware of the patients' backgrounds or other test results, including thoracic ultrasound. In some studies, the ultrasound operators were aware of the patients' background information before performing the thoracic ultrasound scan.