Bennett Olivia M, Sears Erika D
From the University of Michigan Medical School, Ann Arbor, Mich.
Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, Mich.
Plast Reconstr Surg Glob Open. 2023 Jul 3;11(7):e5067. doi: 10.1097/GOX.0000000000005067. eCollection 2023 Jul.
Lack of a reliable reference standard for carpal tunnel syndrome (CTS) diagnosis could impact the diagnostic test characteristics. This systematic review sought to evaluate differences in the accuracy of CTS diagnostic modalities based on the reference standard used.
A systematic review was performed following PRISMA guidelines to investigate diagnostic modalities used in CTS. A literature search of Embase, PubMed, and Cochrane Reviews was conducted for the years of 2010-2021 for primary data, and 113 studies met final inclusion criteria. Studies were stratified based on the reference standard utilized and diagnostic modality assessed, and the weighted means of the sensitivities and specificities were calculated.
Thirty-five studies used clinical diagnosis alone as a reference standard, and 78 studies used electrodiagnostic study (EDS). The specificity for MRI and ultrasound (US) were substantially lower when EDS was used as the reference standard. MRI was the test most affected by the reference standard used, showing increased sensitivity when using EDS as the reference compared to clinical diagnosis (77.1% versus 60.9%) and decreased specificity (87.6% versus 99.2%). Regardless of the reference standard used, all tests had anticipated false-positive and/or false-negative rates of at least 10%.
Testing characteristics vary greatly based on the choice of reference standard, with the sensitivity of MRI most affected. Regardless of reference standard used, EDS, US, and MRI each had false-positive and/or false-negative rates too great to be appropriate for use as a screening examination.
缺乏用于腕管综合征（CTS）诊断的可靠参考标准可能会影响诊断测试的特征。本系统评价旨在评估基于所使用的参考标准，CTS诊断方法在准确性上的差异。
按照PRISMA指南进行系统评价，以研究CTS中使用的诊断方法。对Embase、PubMed和Cochrane综述进行文献检索，获取2010 - 2021年的原始数据，113项研究符合最终纳入标准。根据所使用的参考标准和评估的诊断方法对研究进行分层，并计算敏感性和特异性的加权平均值。
35项研究仅将临床诊断用作参考标准，78项研究使用了电诊断研究（EDS）。当以EDS作为参考标准时，MRI和超声（US）的特异性显著降低。MRI是受所使用的参考标准影响最大的测试，与临床诊断相比，以EDS作为参考时其敏感性增加（77.1%对60.9%），特异性降低（87.6%对99.2%）。无论使用何种参考标准，所有测试都有至少10%的预期假阳性和/或假阴性率。
测试特征因参考标准的选择而有很大差异，MRI的敏感性受影响最大。无论使用何种参考标准，EDS、US和MRI的假阳性和/或假阴性率都过高，不适合用作筛查检查。
