Diagnostic performance of different methods for diagnosis of pseudoprogression after immunotherapy treatment: a systematic review and meta-analysis

Background The purpose of this meta-analysis was to evaluate the diagnostic performance of different methods for pseudoprogression after immunotherapy treatment. Methods This systematic review adhered to the PRISMA for diagnostic test accuracy guidelines. The PubMed, Embase, and Cochrane Library databases were searched comprehensively for relevant studies up to October 01, 2023 according to specific inclusion and exclusion criteria. The quality of the included studies was assessed according to the quality assessment of diagnostic accuracy studies (QUADAS-2). After performing heterogeneity and threshold effect tests, pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. Publication bias was evaluated visually and estimated by Deeks’ funnel plot. The area under the summary receiver operating characteristic (SROC) curve was calculated to demonstrate the diagnostic performance of modality. Results Five studies covering 250 lesions evaluating laboratory, image, and radiomics were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 77% (95% confidence interval [CI] 72%-81%), 70% (95% CI 66%-75%), 2.58 (95% CI 2.14–3.07), 0.33 (95% CI 0.27–0.40), and 7.88 (95% CI 5.59–10.52), respectively. The area under the SROC curve was 0.807. In addition, the SROC curve showed high sensitivities (0.77) and low false positive rates (0.33) suggested that the results were reliable. Furthermore, the Deeks’ funnel plot suggested no notable publication bias. No heterogeneity (I2 < 50%) was observed in the analysis of pooled studies. Conclusion Our review suggests that laboratory and images offered the optimal diagnostic performance of pseudoprogression after immunotherapy treatment.