Search

Aim: To quantify the overall diagnostic accuracy of the Mayo model in predicting the probability of malignancy of solitary pulmonary nodules (SPNs) by carrying out a systematic review and meta-analysis. Materials and methods: PubMed, Scopus, and references of relevant articles were searched systematically from inception up to 21 September 2021, to identify observational cohort studies, which reported on the diagnostic accuracy of the Mayo model in predicting the probability of malignancy in SPNs. The primary outcome was the pooled area under the receiver operating characteristic (ROC) curve (AUC). Secondary outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR). The meta-analysis was registered with PROSPERO. Results: Forty studies involving 46,694 patients were included. The overall pooled AUC was 0.730 (95% confidence interval [CI]: 0.704–0.755), while sensitivity and specificity were 0.78 (95% CI: 0.67–0.86) and 0.68 (95% CI: 0.57–0.77), respectively. Subgroup analyses revealed that the model had a better performance among datasets with increased prevalence of current/ex-smokers (AUC 0.762, 95% CI: 0.713–0.810, versus AUC 0.695, 95% CI: 0.660–0.730 and among studies conducted in continents other than Asia (AUC 0.769, 95% CI: 0.732–0.806 versus AUC 0.699, 95% CI: 0.669–0.729, p<0.001, I2=91.20%) Conclusions: The Mayo model seems a fair diagnostic tool; however, the synthesised evidence informs clinicians and researchers that it may be more applicable on certain patient populations, such as smokers and non-Asians. © 2022 The Royal College of Radiologists

Background: Noninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it. Aim: The study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure. Methods: We designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and P-aCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain S-pO2 between 88%-92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death. Conclusion: Given the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.