How to conduct a systematic review and meta-analysis of comparative diagnostic test accuracy_Chinese Journal of Evidence-Based Medicine

Authors：

LU Yao ^1,2 , YANG Qiuyu ³ , LIU Yafei ^1,2 , LAI Honghao ^1,2 , TIAN Chen ^1,2 , TIAN Jinhui ^4,5 ,  LI Jiang ⁶ ,  GE Long ^1,2,5

1. Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
2. Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
3. Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou 730000, P. R. China;
4. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
5. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, P. R. China;
6. National Cancer Center/National Cancer Clinical Medical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P. R. China;

Corresponding author：

LI Jiang, Email: lij@cicams.ac.cn; GE Long, Email: gelong2009@163.com

Keywords：

Diagnostic test; Comparative diagnostic test accuracy; Systematic review; Meta-analysis; Evidence-based medicine

DOI：

10.7507/1672-2531.202206024

Video：

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The comparative diagnostic test accuracy (CDTA) study is an important part of diagnostic test accuracy, which aims to compare the accuracy of two or more index tests in the same study. With the development of CDTA studies and the methodology of systematic reviews, the number of CDTA systematic reviews has grown year by year and has provided evidence to support clinical decision-making. Compared with systematic review of single diagnostic test accuracy, the CDTA systematic review has its own unique features, especially in data extraction, risk of bias, and statistical analysis. This paper introduced the steps and precautions for writing a CDTA systematic review to provide references for CDTA systematic reviewers.

Citation： LU Yao, YANG Qiuyu, LIU Yafei, LAI Honghao, TIAN Chen, TIAN Jinhui, LI Jiang, GE Long. How to conduct a systematic review and meta-analysis of comparative diagnostic test accuracy. Chinese Journal of Evidence-Based Medicine, 2022, 22(11): 1339-1347. doi: 10.7507/1672-2531.202206024 Copy

1.	田金徽. 系统评价再评价撰写注意事项. 中国药物评价, 2019, 36(1): 1-4.
2.	Gurevitch J, Koricheva J, Nakagawa S, et al. Meta-analysis and the science of research synthesis. Nature, 2018, 555(7695): 175-182.
3.	Leeflang MM. Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infect, 2014, 20(2): 105-113.
4.	Takwoingi Y, Leeflang MM, Deeks JJ. Empirical evidence of the importance of comparative studies of diagnostic test accuracy. Ann Intern Med, 2013, 158(7): 544-554.
5.	Yang B, Vali Y, Dehmoobad Sharifabadi A, et al. Risk of bias assessment of test comparisons was uncommon in comparative accuracy systematic reviews: an overview of reviews. J Clin Epidemiol, 2020, 127: 167-174.
6.	Galm BP, Qiao N, Klibanski A, et al. Accuracy of laboratory tests for the diagnosis of Cushing syndrome. J Clin Endocrinol Metab, 2020, 105(6): dgaa105.
7.	Takwoingi Y, Partlett C, Riley RD, et al. Methods and reporting of systematic reviews of comparative accuracy were deficient: a methodological survey and proposed guidance. J Clin Epidemiol, 2020, 121: 1-14.
8.	田晨, 杨秋玉, 赖鸿皓, 等. 诊断性试验准确性比较研究. 中国循证医学杂志, 2022, 22(5): 590-594.
9.	杨秋玉, 陆瑶, 田晨, 等. 诊断试验准确性比较研究: 研究设计. 中国循证医学杂志, 2022, 22(6): 739-744.
10.	Muka T, Glisic M, Milic J, et al. A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research. Eur J Epidemiol, 2020, 35(1): 49-60.
11.	Cronin P, Kelly AM, Altaee D, et al. How to perform a systematic review and meta-analysis of diagnostic imaging studies. Acad Radiol, 2018, 25(5): 573-593.
12.	Leeflang MM, Davenport C, Bossuyt PM. Chapter 6: defining the review question // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane Handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
13.	张永刚, 杨乐天, 杨鑫, 等. 诊断准确性试验的系统评价/Meta分析报告规范(PRISMA-DTA)的解读. 中国循证医学杂志, 2018, 18(9): 1007-1016.
14.	Salameh JP, Bossuyt PM, McGrath TA, et al. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ, 2020, 370: m2632.
15.	Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 2021, 372: n160.
16.	Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev, 2021, 10(1): 39.
17.	Bramer WM, Rethlefsen ML, Kleijnen J, et al. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev, 2017, 6(1): 245.
18.	McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA, 2018, 319(4): 388-396.
19.	Dinnes J, Deeks JJ, Leeflang MM, et al. Chapter 8: collecting data // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
20.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
21.	Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
22.	Bossuyt PM. Chapter 4: understanding the design of test accuracy studies // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
23.	Deeks JJ, Takwoingi Y, Macaskill P, et al. Chapter 5: understanding test accuracy measures // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
24.	Hayen A, Macaskill P, Irwig L, et al. Appropriate statistical methods are required to assess diagnostic tests for replacement, add-on, and triage. J Clin Epidemiol, 2010, 63(8): 883-891.
25.	Jones AP, Remmington T, Williamson PR, et al. High prevalence but low impact of data extraction and reporting errors were found in Cochrane systematic reviews. J Clin Epidemiol, 2005, 58(7): 741-742.
26.	Clark J, Glasziou P, Del Mar C, et al. A full systematic review was completed in 2 weeks using automation tools: a case study. J Clin Epidemiol, 2020, 121: 81-90.
27.	Beller E, Clark J, Tsafnat G, et al. Making progress with the automation of systematic reviews: principles of the International Collaboration for the Automation of Systematic Reviews (ICASR). Syst Rev, 2018, 7(1): 77.
28.	Scott AM, Forbes C, Clark J, et al. Systematic review automation tools improve efficiency but lack of knowledge impedes their adoption: a survey. J Clin Epidemiol, 2021, 138: 80-94.
29.	Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 2003, 3: 25.
30.	Yang B, Mustafa RA, Bossuyt PM, et al. GRADE Guidance: 31. Assessing the certainty across a body of evidence for comparative test accuracy. J Clin Epidemiol, 2021, 136: 146-156.
31.	Macaskill P, Takwoingi Y, Deeks JJ, et al. Chapter 10: understanding meta-analysis // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
32.	Reitsma JB, Glas AS, Rutjes AW, et al. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol, 2005, 58(10): 982-990.
33.	Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med, 2001, 20(19): 2865-2884.
34.	Trikalinos TA, Hoaglin DC, Small KM, et al. Methods for the joint meta-analysis of multiple tests. Res Synth Methods, 2014, 5(4): 294-312.
35.	Dimou NL, Adam M, Bagos PG. A multivariate method for meta-analysis and comparison of diagnostic tests. Stat Med, 2016, 35(20): 3509-3523.
36.	Siadaty MS, Shu J. Proportional odds ratio model for comparison of diagnostic tests in meta-analysis. BMC Med Res Methodol, 2004, 4(1): 27.
37.	Naaktgeboren CA, van Enst WA, Ochodo EA, et al. Systematic overview finds variation in approaches to investigating and reporting on sources of heterogeneity in systematic reviews of diagnostic studies. J Clin Epidemiol, 2014, 67(11): 1200-1209.
38.	Andrade C. Understanding the basics of meta-analysis and how to read a forest plot: as simple as it gets. J Clin Psychiatry, 2020, 81(5): 20f13698.
39.	Zhou Y, Dendukuri N. Statistics for quantifying heterogeneity in univariate and bivariate meta-analyses of binary data: the case of meta-analyses of diagnostic accuracy. Stat Med, 2014, 33(16): 2701-2717.
40.	van Enst WA, Ochodo E, Scholten RJ, et al. Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study. BMC Med Res Methodol, 2014, 14: 70.
41.	Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol, 2005, 58(9): 882-893.
42.	Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
43.	Bürkner PC, Doebler P. Testing for publication bias in diagnostic meta-analysis: a simulation study. Stat Med, 2014, 33(18): 3061-3077.
44.	Begg CB. Systematic reviews of diagnostic accuracy studies require study by study examination: first for heterogeneity, and then for sources of heterogeneity. J Clin Epidemiol, 2005, 58(9): 865-866.
45.	张天嵩, 钟文昭. 非参数剪补法在Stata中的实现. 循证医学, 2009, 9(4): 240-242.
46.	Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 21 part 2. Test accuracy: inconsistency, imprecision, publication bias, and other domains for rating the certainty of evidence and presenting it in evidence profiles and summary of findings tables. J Clin Epidemiol, 2020, 122: 142-152.
47.	Merckx J, Wali R, Schiller I, et al. Diagnostic accuracy of novel and traditional rapid tests for influenza infection compared with reverse transcriptase polymerase chain reaction: a systematic review and meta-analysis. Ann Intern Med, 2017, 167(6): 394-409.
48.	Chen L, Yang Q, Bao J, et al. Direct comparison of PET/CT and MRI to predict the pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Sci Rep, 2017, 7(1): 8479.
49.	高亚, 刘明, 杨珂璐, 等. 系统评价报告规范: PRISMA2020与PRISMA2009的对比分析与实例解读. 中国循证医学杂志, 2021, 21(5): 606-616.
50.	Ferrante di Ruffano L, Hyde CJ, McCaffery KJ, et al. Assessing the value of diagnostic tests: a framework for designing and evaluating trials. BMJ, 2012, 344: e686.
51.	Beynon R, Leeflang MM, McDonald S, et al. Search strategies to identify diagnostic accuracy studies in MEDLINE and EMBASE. Cochrane Database Syst Rev, 2013, (9): MR000022.

1. 田金徽. 系统评价再评价撰写注意事项. 中国药物评价, 2019, 36(1): 1-4.
2. Gurevitch J, Koricheva J, Nakagawa S, et al. Meta-analysis and the science of research synthesis. Nature, 2018, 555(7695): 175-182.
3. Leeflang MM. Systematic reviews and meta-analyses of diagnostic test accuracy. Clin Microbiol Infect, 2014, 20(2): 105-113.
4. Takwoingi Y, Leeflang MM, Deeks JJ. Empirical evidence of the importance of comparative studies of diagnostic test accuracy. Ann Intern Med, 2013, 158(7): 544-554.
5. Yang B, Vali Y, Dehmoobad Sharifabadi A, et al. Risk of bias assessment of test comparisons was uncommon in comparative accuracy systematic reviews: an overview of reviews. J Clin Epidemiol, 2020, 127: 167-174.
6. Galm BP, Qiao N, Klibanski A, et al. Accuracy of laboratory tests for the diagnosis of Cushing syndrome. J Clin Endocrinol Metab, 2020, 105(6): dgaa105.
7. Takwoingi Y, Partlett C, Riley RD, et al. Methods and reporting of systematic reviews of comparative accuracy were deficient: a methodological survey and proposed guidance. J Clin Epidemiol, 2020, 121: 1-14.
8. 田晨, 杨秋玉, 赖鸿皓, 等. 诊断性试验准确性比较研究. 中国循证医学杂志, 2022, 22(5): 590-594.
9. 杨秋玉, 陆瑶, 田晨, 等. 诊断试验准确性比较研究: 研究设计. 中国循证医学杂志, 2022, 22(6): 739-744.
10. Muka T, Glisic M, Milic J, et al. A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research. Eur J Epidemiol, 2020, 35(1): 49-60.
11. Cronin P, Kelly AM, Altaee D, et al. How to perform a systematic review and meta-analysis of diagnostic imaging studies. Acad Radiol, 2018, 25(5): 573-593.
12. Leeflang MM, Davenport C, Bossuyt PM. Chapter 6: defining the review question // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane Handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
13. 张永刚, 杨乐天, 杨鑫, 等. 诊断准确性试验的系统评价/Meta分析报告规范(PRISMA-DTA)的解读. 中国循证医学杂志, 2018, 18(9): 1007-1016.
14. Salameh JP, Bossuyt PM, McGrath TA, et al. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ, 2020, 370: m2632.
15. Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 2021, 372: n160.
16. Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev, 2021, 10(1): 39.
17. Bramer WM, Rethlefsen ML, Kleijnen J, et al. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev, 2017, 6(1): 245.
18. McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA, 2018, 319(4): 388-396.
19. Dinnes J, Deeks JJ, Leeflang MM, et al. Chapter 8: collecting data // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
20. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
21. Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
22. Bossuyt PM. Chapter 4: understanding the design of test accuracy studies // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
23. Deeks JJ, Takwoingi Y, Macaskill P, et al. Chapter 5: understanding test accuracy measures // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
24. Hayen A, Macaskill P, Irwig L, et al. Appropriate statistical methods are required to assess diagnostic tests for replacement, add-on, and triage. J Clin Epidemiol, 2010, 63(8): 883-891.
25. Jones AP, Remmington T, Williamson PR, et al. High prevalence but low impact of data extraction and reporting errors were found in Cochrane systematic reviews. J Clin Epidemiol, 2005, 58(7): 741-742.
26. Clark J, Glasziou P, Del Mar C, et al. A full systematic review was completed in 2 weeks using automation tools: a case study. J Clin Epidemiol, 2020, 121: 81-90.
27. Beller E, Clark J, Tsafnat G, et al. Making progress with the automation of systematic reviews: principles of the International Collaboration for the Automation of Systematic Reviews (ICASR). Syst Rev, 2018, 7(1): 77.
28. Scott AM, Forbes C, Clark J, et al. Systematic review automation tools improve efficiency but lack of knowledge impedes their adoption: a survey. J Clin Epidemiol, 2021, 138: 80-94.
29. Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 2003, 3: 25.
30. Yang B, Mustafa RA, Bossuyt PM, et al. GRADE Guidance: 31. Assessing the certainty across a body of evidence for comparative test accuracy. J Clin Epidemiol, 2021, 136: 146-156.
31. Macaskill P, Takwoingi Y, Deeks JJ, et al. Chapter 10: understanding meta-analysis // Deeks JJ, Bossuyt PM, Leeflang MM, et al. Cochrane handbook for systematic reviews of diagnostic test accuracy version 2. London: Cochrane, 2022. Available at: https://training.cochrane.org/handbook-diagnostic-test-accuracy.
32. Reitsma JB, Glas AS, Rutjes AW, et al. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol, 2005, 58(10): 982-990.
33. Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med, 2001, 20(19): 2865-2884.
34. Trikalinos TA, Hoaglin DC, Small KM, et al. Methods for the joint meta-analysis of multiple tests. Res Synth Methods, 2014, 5(4): 294-312.
35. Dimou NL, Adam M, Bagos PG. A multivariate method for meta-analysis and comparison of diagnostic tests. Stat Med, 2016, 35(20): 3509-3523.
36. Siadaty MS, Shu J. Proportional odds ratio model for comparison of diagnostic tests in meta-analysis. BMC Med Res Methodol, 2004, 4(1): 27.
37. Naaktgeboren CA, van Enst WA, Ochodo EA, et al. Systematic overview finds variation in approaches to investigating and reporting on sources of heterogeneity in systematic reviews of diagnostic studies. J Clin Epidemiol, 2014, 67(11): 1200-1209.
38. Andrade C. Understanding the basics of meta-analysis and how to read a forest plot: as simple as it gets. J Clin Psychiatry, 2020, 81(5): 20f13698.
39. Zhou Y, Dendukuri N. Statistics for quantifying heterogeneity in univariate and bivariate meta-analyses of binary data: the case of meta-analyses of diagnostic accuracy. Stat Med, 2014, 33(16): 2701-2717.
40. van Enst WA, Ochodo E, Scholten RJ, et al. Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study. BMC Med Res Methodol, 2014, 14: 70.
41. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol, 2005, 58(9): 882-893.
42. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
43. Bürkner PC, Doebler P. Testing for publication bias in diagnostic meta-analysis: a simulation study. Stat Med, 2014, 33(18): 3061-3077.
44. Begg CB. Systematic reviews of diagnostic accuracy studies require study by study examination: first for heterogeneity, and then for sources of heterogeneity. J Clin Epidemiol, 2005, 58(9): 865-866.
45. 张天嵩, 钟文昭. 非参数剪补法在Stata中的实现. 循证医学, 2009, 9(4): 240-242.
46. Schünemann HJ, Mustafa RA, Brozek J, et al. GRADE guidelines: 21 part 2. Test accuracy: inconsistency, imprecision, publication bias, and other domains for rating the certainty of evidence and presenting it in evidence profiles and summary of findings tables. J Clin Epidemiol, 2020, 122: 142-152.
47. Merckx J, Wali R, Schiller I, et al. Diagnostic accuracy of novel and traditional rapid tests for influenza infection compared with reverse transcriptase polymerase chain reaction: a systematic review and meta-analysis. Ann Intern Med, 2017, 167(6): 394-409.
48. Chen L, Yang Q, Bao J, et al. Direct comparison of PET/CT and MRI to predict the pathological response to neoadjuvant chemotherapy in breast cancer: a meta-analysis. Sci Rep, 2017, 7(1): 8479.
49. 高亚, 刘明, 杨珂璐, 等. 系统评价报告规范: PRISMA2020与PRISMA2009的对比分析与实例解读. 中国循证医学杂志, 2021, 21(5): 606-616.
50. Ferrante di Ruffano L, Hyde CJ, McCaffery KJ, et al. Assessing the value of diagnostic tests: a framework for designing and evaluating trials. BMJ, 2012, 344: e686.
51. Beynon R, Leeflang MM, McDonald S, et al. Search strategies to identify diagnostic accuracy studies in MEDLINE and EMBASE. Cochrane Database Syst Rev, 2013, (9): MR000022.

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