Diagnostic values of ten methods in patients with onychomycosis: A network meta-analysis

BackgroundOnychomycosis, a disease was with a high global prevalence, has been the focal point of this study. The research aims to compare diagnostic efficacy among various methods, including potassium hydroxide (KOH), Dimethyl sulfoxide (DMSO), specific colour staining (Chlorazol, lactophenol cotton blue and Chicago sky blue stain), fluorescent staining (calcofluor white stain, acridine orange fluorescent dye), culture on dermatophyte test medium (DTM), conventional PCR, dermoscopy, histopathological examination using PAS stain (HEP-PAS), real-time PCR and multiple PCR. This comparison was achieved through a network meta-analysis involving patients with onychomycosis.MethodsA comprehensive literature search was conducted across eight databases. Subsequently, both direct and indirect evidence were amalgamated to assess sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. This combination analysis helped to estimate the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the nine different methods, providing an in-depth perspective on diagnosing onychomycosis.ResultsThe network meta-analysis integrated 20 eligible diagnostic trials. The results exhibited that DTM provided higher sensitivity, NPV and accuracy, as indicated by SUCRA values. Meanwhile, DMSO demonstrated higher specificity and positive predictive value in terms of SUCRA values. Among the nine methods, fluorescent staining showcased comparatively superior sensitivity, specificity, NPV, PPV and accuracy. Furthermore, a cluster analysis indicated that DTM held the highest diagnostic value for sensitivity and accuracy among the nine techniques, with fluorescence staining ranking second.ConclusionThis network meta-analysis strengthens the evidence suggesting that fluorescence staining exhibits strong diagnostic value in onychomycosis. This finding bears diagnostic implications for onychomycosis.