2. The Sensitivity and Specificity of Pooled Studies
Sensitivity and specificity are the most important and widely used statistic indexes for a diagnostic
test. It is widely accepted that the sensitivity of a test is its true positive response, and the specificity is
its true negative response. As calculated by the bivariate meta-analysis, the overall sensitivity and
specificity of these studies were 75% (0.70–0.80) and 85% (0.81–0.91) with 95% CIs. Figure 2A shows
the forest plot of sensitivities of all included studies and the overall sensitivity. The red line represents
overall sensitivity with hepatocellular cancer (HCC) [32], CC [34] and LSCC [33] studies on the left
of the red line, indicating that their sensitivities were less than 75%, while other studies are on the
right. In the HCC study, 13 patients in advanced tumor stages (III and IV) and 30 healthy volunteers
as controls were included with high expression of miR-21 as the cutoff point [33]. In the ESCC study,
there were two groups, which were difficult to combine. One group of 44 patients and 41 controls
was included with 0.02-fold as the cutoff point [37]. The gastric cancer (GC) study had no healthy
control, and thus, patients at stage T1-2 were used as controls for patients at stage T3–4 [42]. In the
breast cancer (BC) study, after exosomes were harvested from the serum of healthy controls and breast
cancer patients, they were left in cell-free culture conditions for 24 h or 72 h, followed by qPCR being
performed for all samples at the two time points. The fold-change of exosome miR-21 at 72 h was
quantified relative to the exosomal miRNA at 24 h [39]. We chose 1.5-fold as the cutoff points in
this study.
2. The Sensitivity and Specificity of Pooled StudiesSensitivity and specificity are the most important and widely used statistic indexes for a diagnostictest. It is widely accepted that the sensitivity of a test is its true positive response, and the specificity isits true negative response. As calculated by the bivariate meta-analysis, the overall sensitivity andspecificity of these studies were 75% (0.70–0.80) and 85% (0.81–0.91) with 95% CIs. Figure 2A showsthe forest plot of sensitivities of all included studies and the overall sensitivity. The red line representsoverall sensitivity with hepatocellular cancer (HCC) [32], CC [34] and LSCC [33] studies on the leftof the red line, indicating that their sensitivities were less than 75%, while other studies are on theright. In the HCC study, 13 patients in advanced tumor stages (III and IV) and 30 healthy volunteersas controls were included with high expression of miR-21 as the cutoff point [33]. In the ESCC study,there were two groups, which were difficult to combine. One group of 44 patients and 41 controlswas included with 0.02-fold as the cutoff point [37]. The gastric cancer (GC) study had no healthycontrol, and thus, patients at stage T1-2 were used as controls for patients at stage T3–4 [42]. In thebreast cancer (BC) study, after exosomes were harvested from the serum of healthy controls and breastcancer patients, they were left in cell-free culture conditions for 24 h or 72 h, followed by qPCR beingperformed for all samples at the two time points. The fold-change of exosome miR-21 at 72 h wasquantified relative to the exosomal miRNA at 24 h [39]. We chose 1.5-fold as the cutoff points inthis study.
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