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. 2021 Apr 15;2021(4):CD013346. doi: 10.1002/14651858.CD013346.pub2

Long 2011.

Study characteristics
Patient Sampling Blood samples were obtained from 111 patients with HCC (Beijing Youan Hospital and Beijing Chaoyang Hospital), 36 patients with liver cirrhosis (LC) (Beijing Youan Hospital; 26 with Child‐Pugh class A and 10 with Child‐Pugh class B), 33 patients with chronic hepatitis B (CHB) (Beijing Youan Hospital), 9 patients with colorectal carcinoma, 11 patients with lung carcinoma, 10 patients with breast carcinoma, 8 patients with cerebral vascular accident, 7 patients with myositis, and 100 healthy blood donors.
Age range: 29‐65. Males 69%
Patient characteristics and setting  
Index tests AFP: the cut‐off value considered positive for AFP was 20 ng/mL.
Target condition and reference standard(s) HCC: no information regarding reference standard
Flow and timing No information on interval between index test and reference standard
Comparative  
Notes The authors reported no conflicts of interest.
Methodological quality
Item Authors' judgement Risk of bias Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled? No    
Was a case‐control design avoided? No    
Did the study avoid inappropriate exclusions? Unclear    
Could the selection of patients have introduced bias?   High risk  
Are there concerns that the included patients and setting do not match the review question?     High
DOMAIN 2: Index Test (AFP)
Were the index test results interpreted without knowledge of the results of the reference standard? No    
If a threshold was used, was it pre‐specified? Yes    
Could the conduct or interpretation of the index test have introduced bias?   High risk  
Are there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern
DOMAIN 2: Index Test (US+AFP)
DOMAIN 2: Index Test (US)
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition? Unclear    
Were the reference standard results interpreted without knowledge of the results of the index tests? Unclear    
Could the reference standard, its conduct, or its interpretation have introduced bias?   Unclear risk  
Are there concerns that the target condition as defined by the reference standard does not match the question?     Unclear
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard? Unclear    
Did all patients receive the same reference standard? Unclear    
Were all patients included in the analysis? Yes    
Could the patient flow have introduced bias?   High risk