If the applicability of an article

could not be determined by title or abstract alone, the full text was reviewed. Any disagreements were arbitrated by a third reviewer. The studies were selected if they fulfilled the following inclusion criteria: (i) retrospective or prospective studies; (ii) compared DCP with AFP for HCC surveillance among the same patients in each study; (iii) histology, typical imaging characteristics, AFP ≥200 ng/mL with mass lesion on imaging were used as the reference standard for detecting HCC; (iv) only articles presenting sufficient data to Pirfenidone mw calculate the true-positive (TP), false-positive (FP), false-negative (FN), and true-negative (TN) values were included. If data were not available in the studies, we contacted the corresponding authors to provide supplemental data; and

(v) Staging according to the Barcelona Clinic Liver Cancer staging system (BCLC). Early stage is defined as a single lesion <3 cm in diameter or this website no more than three lesions with each <3 cm and without portal vein thrombosis or extrahepatic metastasis.[6] Studies evaluated less than 30 patients, abstracts, letters, editorials and expert opinions, reviews without original data, meta-analysis, case reports and studies lacking control groups were excluded. Two authors independently extracted data from the selected studies. We recorded the following information of each individual study: journal name, year of publication, setting, number and characteristics of participants, index tests, cut-off value, study design, method of recruitment, and the reference standard. Any disagreement was resolved through consultation with the third reviewer. Two authors independently assessed the methodological quality of each included study using QUADAS-2 (A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies)[42] recommended by the Cochrane Collaboration. This tool, aims to evaluate bias and applicability, consists of four key domains including patient selection, index test, reference standard, and flow and timing. All domains check details can assess the risk of bias, and the first

three domains can also assess concerns about applicability. We resolved any discrepancy by a third reviewer. We constructed two by two tables of true positive cases, false positive cases, false negative cases, and true negative cases. The data were independently extracted by two authors to ensure consistency and inputted in to Review Manager Software 5.2 (updated in March 2012 by the Cochrane Collaboration). We calculated summary sensitivities and specificities, and area under the receiver operating curve (AUROC) using random-effect bivariate meta-analysis model by STATA 12 with the METADI and MIDAS commands (StataCorp, College Station, TX, USA). Forest plots and the summary receiver operating curve (SROC) plot were introduced to look for heterogeneity within sensitivity and specificity.