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      Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part I. General Guidance and Tips

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          Abstract

          In the field of diagnostic test accuracy (DTA), the use of systematic review and meta-analyses is steadily increasing. By means of objective evaluation of all available primary studies, these two processes generate an evidence-based systematic summary regarding a specific research topic. The methodology for systematic review and meta-analysis in DTA studies differs from that in therapeutic/interventional studies, and its content is still evolving. Here we review the overall process from a practical standpoint, which may serve as a reference for those who implement these methods.

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          Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests.

          J J Deeks (2001)
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            Sources of variation and bias in studies of diagnostic accuracy: a systematic review.

            Penny Whiting, Anne Rutjes, Johannes Reitsma … (2004)
            Studies of diagnostic accuracy are subject to different sources of bias and variation than studies that evaluate the effectiveness of an intervention. Little is known about the effects of these sources of bias and variation. To summarize the evidence on factors that can lead to bias or variation in the results of diagnostic accuracy studies. MEDLINE, EMBASE, and BIOSIS, and the methodologic databases of the Centre for Reviews and Dissemination and the Cochrane Collaboration. Methodologic experts in diagnostic tests were contacted. Studies that investigated the effects of bias and variation on measures of test performance were eligible for inclusion, which was assessed by one reviewer and checked by a second reviewer. Discrepancies were resolved through discussion. Data extraction was conducted by one reviewer and checked by a second reviewer. The best-documented effects of bias and variation were found for demographic features, disease prevalence and severity, partial verification bias, clinical review bias, and observer and instrument variation. For other sources, such as distorted selection of participants, absent or inappropriate reference standard, differential verification bias, and review bias, the amount of evidence was limited. Evidence was lacking for other features, including incorporation bias, treatment paradox, arbitrary choice of threshold value, and dropouts. Many issues in the design and conduct of diagnostic accuracy studies can lead to bias or variation; however, the empirical evidence about the size and effect of these issues is limited.
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              Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part II. Statistical Methods of Meta-Analysis

              Juneyoung Lee, Kyung Won Kim, Sang Choi … (2015)
              Meta-analysis of diagnostic test accuracy studies differs from the usual meta-analysis of therapeutic/interventional studies in that, it is required to simultaneously analyze a pair of two outcome measures such as sensitivity and specificity, instead of a single outcome. Since sensitivity and specificity are generally inversely correlated and could be affected by a threshold effect, more sophisticated statistical methods are required for the meta-analysis of diagnostic test accuracy. Hierarchical models including the bivariate model and the hierarchical summary receiver operating characteristic model are increasingly being accepted as standard methods for meta-analysis of diagnostic test accuracy studies. We provide a conceptual review of statistical methods currently used and recommended for meta-analysis of diagnostic test accuracy studies. This article could serve as a methodological reference for those who perform systematic review and meta-analysis of diagnostic test accuracy studies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Radiol
                Journal ID (iso-abbrev): Korean J Radiol
                Journal ID (publisher-id): KJR
                Title: Korean Journal of Radiology
                Publisher: The Korean Society of Radiology
                ISSN (Print): 1229-6929
                ISSN (Electronic): 2005-8330
                Publication date (Print): Nov-Dec 2015
                Publication date (Electronic): 26 October 2015
                Volume: 16
                Issue: 6
                Pages: 1175-1187
                Affiliations
                [1 ]Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.
                [2 ]Department of Biostatistics, Korea University College of Medicine, Seoul 02841, Korea.
                Author notes
                Corresponding author: Seong Ho Park, MD, PhD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: (822) 3010-5984, Fax: (822) 476-4719, parksh.radiology@ 123456gmail.com

                *Kyung Won Kim and Juneyoung Lee contributed equally to this work.

                Article
                DOI: 10.3348/kjr.2015.16.6.1175
                PMC ID: 4644738
                PubMed ID: 26576106
                SO-VID: a049f19f-6263-41f7-9cb2-f39c3bbfee19
                Copyright © Copyright © 2015 The Korean Society of Radiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 July 2015
                Date accepted : 28 August 2015
                Funding
                Funded by: Korea Health Industry Development Institute
                Funded by: Ministry of Health and Welfare
                Award ID: HI14C1090
                Categories
                Subject: Experimental and Others
                Subject: Review Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: systematic review,meta-analysis,diagnostic test accuracy
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: systematic review, meta-analysis, diagnostic test accuracy

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