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Noninvasive Carotid Artery Testing
- Eugene Oddone, MD, MHSc;
- Dean Blakeley, MD; and
- David Matchar, MD
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IN RESPONSE:
We agree with Drs. Howard and Toole that the influence of publication bias can be under-appreciated by readers of meta-analytic reviews. The noninvasive test performance data from the ACAS study underscore the difficulty in making generalizations from published data. Publication bias systematically overestimates the sensitivity of diagnostic tests for the reasons that Drs. Howard and Toole listed. These comments have two important implications: First, noninvasive test performance is operator-dependent and should be the object of quality improvement. As Drs. Howard and Toole note, clinicians must assess the performance of their noninvasive laboratory before referring patients for noninvasive tests. Second, their point reinforces our view that noninvasive tests cannot replace angiography in determining the extent and location of carotid atherosclerosis.
Wong and colleagues expressed concern that we did not discuss functional nuclear noninvasive tests for carotid artery disease. On the basis of a study of 12 patients, they indicate that these tests may be promising. These data do not support meaningful comments about the utility of such tests in evaluating patients for carotid artery stenosis. Until methodologically rigorous studies are done, we cannot clearly determine the operating characteristics of this test.
Eugene Oddone, MD, MHSc
Veterans Affairs Medical Center; Durham, NC 27705
- Copyright ©2004 by the American College of Physicians
