Systematic Reviews of Diagnostic Test Accuracy

TLDR

Systematic reviews of diagnostic test accuracy studies are increasingly common but face methodological challenges, including poor reporting of primary studies and difficulties interpreting results. The paper reviews recent methodological advances for conducting systematic reviews of diagnostic test accuracy studies. Meta‑analysis should account for paired estimates and threshold dependence, using hierarchical summary ROC or bivariate models. Restrictive electronic search filters and summary quality scores are discouraged.

Abstract

More and more systematic reviews of diagnostic test accuracy studies are being published, but they can be methodologically challenging. In this paper, the authors present some of the recent developments in the methodology for conducting systematic reviews of diagnostic test accuracy studies. Restrictive electronic search filters are discouraged, as is the use of summary quality scores. Methods for meta-analysis should take into account the paired nature of the estimates and their dependence on threshold. Authors of these reviews are advised to use the hierarchical summary receiver-operating characteristic or the bivariate model for the data analysis. Challenges that remain are the poor reporting of original diagnostic test accuracy studies and difficulties with the interpretation of the results of diagnostic test accuracy research.