Abuhelwa, Ziad

e15581 Background: Sentinel lymph node (SLN) assessment is critical in colorectal cancer (CRC) for accurate staging and determining optimal treatment strategies. The one-step nucleic acid amplification (OSNA) assay, which measures cytokeratin 19 (CK19) mRNA expression, has shown potential as a molecular diagnostic tool for the intraoperative detection of SLN metastases. This study aims to evaluate the diagnostic accuracy of OSNA for SLN metastasis in CRC. Methods: A systematic search was conducted in PubMed, Cochrane Library, and Web of Science for studies published up to December 2024. Studies reporting diagnostic accuracy metrics for OSNA in detecting SLN metastases in CRC were included. R software (version 4.0.3) with the mada package was used to compute pooled sensitivity, specificity, false-positive rates, diagnostic odds ratios (DOR), and likelihood ratios (LR), all expressed within 95% confidence intervals (CI). Results: Six studies involving 3,016 patients, of whom 363 had SLNs, were included. The pooled sensitivity of OSNA was 91% (95% CI: 84.8–94.8%), while the specificity was 95.6% (95% CI: 91.7–97.8%). The diagnostic odds ratio (DOR) was 220.59 (95% CI: 74.02–657.43). The false-positive rate was 4.4% (95% CI: 2.2–8.3%). The positive likelihood ratio (LR+) was 20.8 (95% CI: 10.5–41.2), and the negative likelihood ratio (LR−) was 0.09 (95% CI: 0.05–0.16). These findings demonstrate that in diagnostic accuracy, OSNA outperforms traditional histopathological methods, such as hematoxylin and eosin (H&E) staining. Conclusions: OSNA demonstrates superior diagnostic accuracy for detecting SLN metastases in colorectal cancer, supporting its integration into clinical workflows. Its high diagnostic accuracy and rapid intraoperative turnaround time make it an invaluable resource for improving surgical decision-making. However, variability in CK19 expression across tissues and the lack of standardized assay thresholds remain challenges that require further investigation. However, its adoption has the potential to enhance staging accuracy and improve surgical and oncological outcomes, warranting broader implementation in CRC management.

Insulin resistance (IR) is a major contributor to the pathogenesis of nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index has recently gained popularity for the assessment of IR and NAFLD due to its ease of acquisition and calculation. Therefore, we conducted this systematic review and meta-analysis to summarize the existing studies in the literature and provide a quantitative assessment of the significance of the TyG index in predicting the incidence of NAFLD. A comprehensive literature search in PubMed, EMBASE, and Web of Science databases from inception until 25 March 2022 was conducted. Published observational studies that evaluated the association between TyG index and NAFLD among the adult population and reported the hazard ratio (HR) or odds ratio (OR) for this association after multivariate analysis were included. The random-effects model was used as the primary statistical analysis model in the estimation of pooled ORs and HRs with the corresponding confidence intervals (CIs). A total of 17 observational studies, including 121,975 participants, were included. For studies analyzing the TyG index as a categorical variable, both pooled OR (6.00, CI 4.12–8.74) and HR (1.70, CI 1.28–2.27) were significant for the association between TyG index and incident NAFLD. For studies analyzing the TyG index as a continuous variable, pooled OR (2.25, CI 1.66–3.04) showed similar results. Consistent results were obtained in subgroup analyses according to the study design, sample size, ethnicity, and diabetic status. In conclusion, our meta-analysis demonstrates that a higher TyG index is associated with higher odds of NAFLD. TyG index may serve as an independent predictive tool to screen patients at high risk of NAFLD in clinical practice, especially in primary care settings. Patients with a high TyG index should be referred for a liver ultrasound and start intense lifestyle modifications. However, further large-scale prospective cohort studies are necessary to validate our findings.