Systematic reviews and meta-analyses of diagnostic studies: a practical guideline

Abstract

Background

Actually, systematic reviews and meta-analyses are the cornerstone of evidence-based practice and the number of these evidence-based articles on diagnostic studies is increasing.

Objective

The aim of this article is to provide a practical guideline for the researchers who intend to perform a systematic review or meta-analysis of diagnostic studies.

Methods

A guideline was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane handbook for systematic reviews of diagnostic test accuracy.

Results

Several steps needed for systematic reviews or meta-analyses of diagnostic studies are briefly discussed (i.e. formulating the question of systematic reviews, search strategy, inclusion and exclusion criteria, quality assessment of the included studies, data extraction, pooling diagnostic indices across studies, reporting heterogeneity and discussion of main findings).

Conclusion

To publish a high-quality systematic review or meta-analysis of diagnostic test accuracy, certain methodology should be followed. Only methodologically sound systematic reviews or meta-analyses can change or support the clinical use of a diagnostic test.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312(7023):71–72

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Sadeghi R, Zakavi R, Kakhki VR (2009) How to apply the evidence-based medicine concept to nuclear medicine diagnostic studies—a review. Nucl Med Rev Cent East Eur 12(2):59–64

    PubMed  Google Scholar 

  3. 3.

    Kianifar HR, Akhondian J, Najafi-Sani M, Sadeghi R (2010) Evidence based medicine in pediatric practice: brief review. Iran J Pediatr 20(3):261–268

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Treglia G, Sadeghi R (2013) Meta-analyses and systematic reviews on PET and PET/CT in oncology: the state of the art. Clin Transl Imaging 1(2):73–75

    Article  Google Scholar 

  5. 5.

    Treglia G, Sadeghi R, Del Sole A, Giovanella L (2014) Diagnostic performance of PET/CT with tracers other than F-18-FDG in oncology: an evidence-based review. Clin Transl Oncol 16(9):770–775

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Smith V, Devane D, Begley CM, Clarke M (2011) Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol 11(1):15

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Khan KS, Kunz R, Kleijnen J, Antes G (2003) Five steps to conducting a systematic review. J R Soc Med 96(3):118–121

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Sadeghi R (2009) Evidence based medicine in nuclear medicine practice, Part I: introduction, asking answerable questions and searching for the best evidence. Iran J Nucl Med 17(1):41–48

    Google Scholar 

  9. 9.

    Sadeghi R (2009) Evidence based medicine in nuclear medicine practice, Part II: appraising and applying the evidence. Iran J Nucl Med 17(1):49–56

    Google Scholar 

  10. 10.

    Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536

    Article  PubMed  Google Scholar 

  11. 11.

    Devillé WL, Buntinx F, Bouter LM et al (2002) Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2:9

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Irwig L, Tosteson AN, Gatsonis C et al (1994) Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 120(8):667–676

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Wallace BC, Schmid CH, Lau J, Trikalinos TA (2009) Meta-analyst: software for meta-analysis of binary, continuous and diagnostic data. BMC Med Res Methodol 9:80

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Higgins JP, Thompson SG, Spiegelhalter DJ (2009) A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 172(1):137–159

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  16. 16.

    Patsopoulos NA, Evangelou E, Ioannidis JP (2008) Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 37(5):1148–1157

    Article  PubMed  Google Scholar 

  17. 17.

    Bae JM (2014) An overview of systematic reviews of diagnostic tests accuracy. Epidemiol Health 36:e2014016

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58(10):982–990

    Article  PubMed  Google Scholar 

  19. 19.

    Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12(14):1293–1316

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Giorgio Treglia.

Ethics declarations

Conflict of interest

All authors (Ramin Sadeghi and Giorgio Treglia) declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sadeghi, R., Treglia, G. Systematic reviews and meta-analyses of diagnostic studies: a practical guideline. Clin Transl Imaging 5, 83–87 (2017). https://doi.org/10.1007/s40336-016-0219-2

Download citation

Keywords

  • Systematic review
  • Meta-analysis
  • Guideline
  • Evidence based medicine