SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Diagnostic accuracy of non-invasive modalities for laryngotracheal stenosis: A systematic review and meta-Analysis.
Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Comment on "Diagnosticaccuracy of non-invasive modalities for laryngotracheal stenosis: A systematicreview and meta-analysis".European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026Article
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No grant is acknowledged in the PubMed record.
Abstract
backgroundLaryngotracheal stenosis (LTS) poses life-threatening risks, with diagnostic delays exacerbating morbidity. Non-invasive diagnostic modalities lack standardized validation, particularly in resource-limited settings.
objectivesTo synthesize diagnostic test accuracy (DTA) evidence for non-invasive LTS modalities (Computed Tomography [CT], CT Virtual Bronchoscopy [CTVB], Spirometry, Magnetic Resonance Imaging [MRI], Ultrasonography, and Conventional Radiography) in adolescents and adults (≥ 12 years), encompassing symptomatic and high-risk asymptomatic populations, and develop evidence-based diagnostic algorithms.
methodsFollowing PRISMA-DTA guidelines, and a PROSPERO-registered protocol (CRD420251044416), 14 studies (30 test evaluations) were identified via systematic searches across eight databases (2000-2025). Bivariate random-effects meta-analysis derived pooled sensitivity/specificity (characterized by HSROC curves), NLR/PLR, DOR, PPV, and NPV. Risk of bias (QUADAS-2), evidence certainty (GRADE), heterogeneity (I²), and pre-specified subgroup/sensitivity analyses were conducted. Laryngotracheobronchoscopy (LTB) or CT served as the reference standard.
resultsPooled sensitivity was 91.5% (95% CI: 88.7-93.6%) and specificity 90.8% (79.7-96.1%), demonstrating excellent rule-out utility (NLR: 0.151) and strong discriminatory power (DOR: 53.123; *p*<0.001), despite substantial heterogeneity (I²>90%). Moderate-certainty evidence identified EDI > 50 spirometry (sensitivity 92% [86-96%], specificity 94% [90-96%]) as optimal for screening (minimizing false positives), and CTVB diameter measurements (sensitivity 92% [85-96%], specificity 88% [80-93%]) for confirmation. MRI exhibited critically low specificity (6-46%; very low certainty). Accuracy improved with age (DOR + 10%/decade; *p*<0.001) and in non-tertiary settings (10.7-fold DOR advantage; *p*<0.001). High prevalence (≥ 50%) doubled false negatives. LIMITATIONS: High heterogeneity, risk of bias (64% studies), spectrum bias (64% surgical cohorts), and absence of LMIC data.
conclusionsEDI > 50 spirometry and CTVB measurements form the evidence-based diagnostic foundation; MRI is contraindicated. Implementation reduces diagnostic delays by 23-41% and unnecessary bronchoscopies by 58%. Policy priorities include integrating standardized protocols into guidelines, scaling spirometry access in LMICs, and prospective validation in non-tertiary/LMIC settings.
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