GRADE

Definitie

Hoog

• er is hoge zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• het is zeer onwaarschijnlijk dat de literatuurconclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Redelijk

• er is redelijke zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• het is mogelijk dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Laag

• er is lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• er is een reële kans dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Zeer laag

• er is zeer lage zekerheid dat het ware effect van behandeling dichtbij het geschatte effect van behandeling ligt;
• de literatuurconclusie is zeer onzeker.

Implicaties van sterke en zwakke aanbevelingen voor verschillende richtlijngebruikers

Sterke aanbeveling

Zwakke (conditionele) aanbeveling

Voor patiënten

De meeste patiënten zouden de aanbevolen interventie of aanpak kiezen en slechts een klein aantal niet.

Een aanzienlijk deel van de patiënten zouden de aanbevolen interventie of aanpak kiezen, maar veel patiënten ook niet. 

Voor behandelaars

De meeste patiënten zouden de aanbevolen interventie of aanpak moeten ontvangen.

Er zijn meerdere geschikte interventies of aanpakken. De patiënt moet worden ondersteund bij de keuze voor de interventie of aanpak die het beste aansluit bij zijn of haar waarden en voorkeuren.

Voor beleidsmakers

De aanbevolen interventie of aanpak kan worden gezien als standaardbeleid.

Beleidsbepaling vereist uitvoerige discussie met betrokkenheid van veel stakeholders. Er is een grotere kans op lokale beleidsverschillen. 

Richtlijn: NVVP – Primaire tumor onbekend

Uitgangsvraag:    Wat is de diagnostische opbrengst van endoscopisch onderzoek bij patiënten met een metastase van een onbekende primaire tumor?

Database(s): Ovid/Medline, Embase

Datum:28-9-2022, 13-2-2023

Periode: 2011-

Talen: nvt

Literatuurspecialist: Ingeborg van Dusseldorp

BMI zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ Bij gebruikmaking van een volledig zoekblok zal naar de betreffende link op de website worden verwezen.

Toelichting:

Voor deze vraag is gezocht met de volgende concepten:

(Endosonography OR fine needle biopsy) AND unknown primary AND sensitiviteit, specificiteit

Op 13 februari 2023 is aanvullend gezocht naar gastroscopie of colonoscopie.

Te gebruiken voor richtlijnen tekst:

In de databases Embase en Ovid/Medline is op 28-9-2022 met relevante zoektermen gezocht vanaf 2011 naar diagnostische studies over endosonography of fine needle biopsy bij patiënten met een onbekende primaire tumor.Op 13-2-2023 is de zoekstrategie aangevuld met diagnostische studies over gastroscopie, colonoscopie. De literatuurzoekactie leverde in totaal 465 unieke treffers op.

Gastroscopie, colonoscopie

EMBASE

OVID/MEDLINE

Ontdubbeld t.o.v. Rayyan 28-9-2023

SRs

10

2

8

Observationele studies

50

19

48

Overige

60

37

67

Totaal

465

Endosonography fine needle

EMBASE

OVID/MEDLINE

Ontdubbeld

SRs

20

11

21

Observationele studies

178

49

185

Overige

106

123

136

Totaal

342

No.

Query

Results

#14

#6 NOT #12 NOT #8 Overige

60

#13

#12 NOT #8 OBS

50

#12

#6 AND #11

187

#11

#9 OR #10

15249329

#10

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

13485820

#9

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

6767914

#8

#6 AND #7 SR

10

#7

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

900453

#6

#4 AND #5

120

#5

'sensitivity and specificity'/de OR sensitiv*:ab,ti OR specific*:ab,ti OR predict*:ab,ti OR 'roc curve':ab,ti OR 'receiver operator':ab,ti OR 'receiver operators':ab,ti OR likelihood:ab,ti OR 'diagnostic error'/exp OR 'diagnostic accuracy'/exp OR 'diagnostic test accuracy study'/exp OR 'inter observer':ab,ti OR 'intra observer':ab,ti OR interobserver:ab,ti OR intraobserver:ab,ti OR validity:ab,ti OR kappa:ab,ti OR reliability:ab,ti OR reproducibility:ab,ti OR ((test NEAR/2 're-test'):ab,ti) OR ((test NEAR/2 'retest'):ab,ti) OR 'reproducibility'/exp OR accuracy:ab,ti OR 'differential diagnosis'/exp OR 'validation study'/de OR 'measurement precision'/exp OR 'diagnostic value'/exp OR 'reliability'/exp OR 'predictive value'/exp OR ppv:ti,ab,kw OR npv:ti,ab,kw

9400601

#4

#3 AND [1-1-2011]/sd NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp)

378

#3

#1 AND #2

1027

#2

'gastrointestinal endoscopy'/exp OR (((gi OR gastrointestin* OR intestin*) NEAR/2 endoscop*):ti,ab,kw) OR gastroscop*:ti,ab,kw OR colonoscop*:ti,ab,kw OR coloscop*:ti,ab,kw

205367

#1

(((unknown OR undetermined OR unidentified OR undefined) NEAR/2 (primar* OR origin*)):ti,ab,kw) AND ('cancer'/exp OR cancer*:ti,ab,kw OR neoplasm*:ti,ab,kw OR tumo*:ti,ab,kw OR carcinoma*:ti,ab,kw OR adeno*:ti,ab,kw OR metasta*:ti,ab,kw OR micrometasta*:ti,ab,kw OR malignan*:ti,ab,kw OR lymphoma*:ti,ab,kw OR sarcoma*:ti,ab,kw OR melanoma*:ti,ab,kw) OR 'cancer of unknown primary site'/exp OR ((occult NEAR/3 (cancer* OR neoplasm* OR tumo* OR carcinoma* OR adeno* OR metasta* OR micrometasta* OR malignan* OR lymphoma* OR sarcoma* OR melanoma*)):ti,ab,kw)

28453

#16 

#8 NOT #14 NOT #10 Overige

106

#15 

#14 NOT #10 OBS

178

#14 

#8 AND #13

187

#13 

#11 OR #12

15249329

#12 

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

13485820

#11 

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

6767914

#10 

#8 AND #9 SR

20

#9 

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

862086

#8 

#6 AND #7

304

#7 

'sensitivity and specificity'/de OR sensitiv*:ab,ti OR specific*:ab,ti OR predict*:ab,ti OR 'roc curve':ab,ti OR 'receiver operator':ab,ti OR 'receiver operators':ab,ti OR likelihood:ab,ti OR 'diagnostic error'/exp OR 'diagnostic accuracy'/exp OR 'diagnostic test accuracy study'/exp OR 'inter observer':ab,ti OR 'intra observer':ab,ti OR interobserver:ab,ti OR intraobserver:ab,ti OR validity:ab,ti OR kappa:ab,ti OR reliability:ab,ti OR reproducibility:ab,ti OR ((test NEAR/2 're-test'):ab,ti) OR ((test NEAR/2 'retest'):ab,ti) OR 'reproducibility'/exp OR accuracy:ab,ti OR 'differential diagnosis'/exp OR 'validation study'/de OR 'measurement precision'/exp OR 'diagnostic value'/exp OR 'reliability'/exp OR 'predictive value'/exp OR ppv:ti,ab,kw OR npv:ti,ab,kw

9400601

#6 

#5 AND [1-1-2011]/sd NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp)

640

#5 

#1 AND #4

1467

#4 

#2 OR #3

115938

#3 

'fine needle aspiration biopsy'/exp OR fnab:ti,ab,kw OR fnac:ti,ab,kw OR (((fine OR ultrasound OR ultrasonic) NEAR/3 needle NEAR/3 (biop* OR aspirat*)):ti,ab,kw) OR 'usfna':ti,ab,kw OR 'usfnab':ti,ab,kw OR 'usfnac':ti,ab,kw OR 'ultrasound-guided fna':ti,ab,kw OR 'ultrasound-guided fnab':ti,ab,kw OR 'ultrasound-guided fnac':ti,ab,kw

74809

#2 

'endobronchial ultrasonography'/exp OR 'endoscopic ultrasonography'/exp OR ebus:ti,ab,kw OR (((endobronch* OR endoscop*) NEAR/3 (echo* OR ultraso*)):ti,ab,kw) OR endosonograph*:ti,ab,kw

54931

#1 

(((unknown OR undetermined OR unidentified OR undefined) NEAR/2 (primar* OR origin*)):ti,ab,kw) AND ('cancer'/exp OR cancer*:ti,ab,kw OR neoplasm*:ti,ab,kw OR tumo*:ti,ab,kw OR carcinoma*:ti,ab,kw OR adeno*:ti,ab,kw OR metasta*:ti,ab,kw OR micrometasta*:ti,ab,kw OR malignan*:ti,ab,kw OR lymphoma*:ti,ab,kw OR sarcoma*:ti,ab,kw OR melanoma*:ti,ab,kw) OR 'cancer of unknown primary site'/exp OR ((occult NEAR/3 (cancer* OR neoplasm* OR tumo* OR carcinoma* OR adeno* OR metasta* OR micrometasta* OR malignan* OR lymphoma* OR sarcoma* OR melanoma*)):ti,ab,kw)

28453

#

Searches

Results

14

7 not 12 not 11

37

13

12 not 11

19

12

7 and (10 or 11)

21

11

7 and 8

2

10

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5353991

9

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4362583

8

meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.

647997

7

5 and 6

58

6

exp "Sensitivity and Specificity"/ or (Sensitiv* or Specific*).ti,ab. or (predict* or ROC-curve or receiver-operator*).ti,ab. or (likelihood or LR*).ti,ab. or exp Diagnostic Errors/ or (inter-observer or intra-observer or interobserver or intraobserver or validity or kappa or reliability).ti,ab. or reproducibility.ti,ab. or (test adj2 (re-test or retest)).ti,ab. or "Reproducibility of Results"/ or accuracy.ti,ab. or Diagnosis, Differential/ or Validation Study/

7706559

5

4 not ((exp animals/ or exp models, animal/) not humans/) not (letter/ or comment/ or editorial/)

184

4

limit 3 to yr="2011 -Current"

185

3

1 and 2

395

2

exp Endoscopy, Gastrointestinal/ or (((gastrointestin$ or intestin$) adj endoscop$) or (gi adj endoscop$)).tw. or gastroscop*.tw. or colonoscop*.tw. or coloscop*.tw.

125352

1

(((unknown or undetermined or unidentified or undefined) adj2 (primar* or origin*)).ti,ab,kf. and (exp Neoplasms/ or cancer*.ti,ab,kf. or neoplasm*.ti,ab,kf. or tumo*.ti,ab,kf. or carcinoma*.ti,ab,kf. or adeno*.ti,ab,kf. or metasta*.ti,ab,kf. or micrometasta*.ti,ab,kf. or malignan*.ti,ab,kf. or lymphoma*.ti,ab,kf. or sarcoma*.ti,ab,kf. or melanoma*.ti,ab,kf.)) or (occult adj3 (cancer* or neoplasm* or tumo* or carcinoma* or adeno* or metasta* or micrometasta* or malignan* or lymphoma* or sarcoma* or melanoma*)).ti,ab,kf. or Neoplasms, Unknown Primary/

19528

#

Searches

Results

16

9 not 14 not 13 Overige

123

15

14 not 13 OBS

49

14

9 and (12 or 13)

60

13

9 and 10 SR

11

12

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5258943

11

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4259097

10

meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.

621260

9

7 and 8

183

8

exp "Sensitivity and Specificity"/ or (Sensitiv* or Specific*).ti,ab. or (predict* or ROC-curve or receiver-operator*).ti,ab. or (likelihood or LR*).ti,ab. or exp Diagnostic Errors/ or (inter-observer or intra-observer or interobserver or intraobserver or validity or kappa or reliability).ti,ab. or reproducibility.ti,ab. or (test adj2 (re-test or retest)).ti,ab. or "Reproducibility of Results"/ or accuracy.ti,ab. or Diagnosis, Differential/ or Validation Study/

7546420

7

6 not ((exp animals/ or exp models, animal/) not humans/) not (letter/ or comment/ or editorial/)

345

6

limit 5 to yr="2011 -Current"

350

5

1 and 4

791

4

2 or 3

64401

3

exp Biopsy, Fine-Needle/ or fnab.ti,ab,kf. or fnac.ti,ab,kf. or ((fine or ultrasound or ultrasonic) adj3 needle adj3 (biop* or aspirat*)).ti,ab,kf. or usfna.ti,ab,kf. or usfnab.ti,ab,kf. or usfnac.ti,ab,kf. or ultrasound-guided fna.ti,ab,kf. or ultrasound-guided fnab.ti,ab,kf. or ultrasound-guided fnac.ti,ab,kf.

44109

2

Endosonography/ or ebus.ti,ab,kf. or ((endobronch* or endoscop*) adj3 (echo* or ultraso*)).ti,ab,kf. or endosonograph*.ti,ab,kf.

27517

1

(((unknown or undetermined or unidentified or undefined) adj2 (primar* or origin*)).ti,ab,kf. and (exp Neoplasms/ or cancer*.ti,ab,kf. or neoplasm*.ti,ab,kf. or tumo*.ti,ab,kf. or carcinoma*.ti,ab,kf. or adeno*.ti,ab,kf. or metasta*.ti,ab,kf. or micrometasta*.ti,ab,kf. or malignan*.ti,ab,kf. or lymphoma*.ti,ab,kf. or sarcoma*.ti,ab,kf. or melanoma*.ti,ab,kf.)) or (occult adj3 (cancer* or neoplasm* or tumo* or carcinoma* or adeno* or metasta* or micrometasta* or malignan* or lymphoma* or sarcoma* or melanoma*)).ti,ab,kf. or Neoplasms, Unknown Primary/

19253