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Meta-analyses of diagnostic studies
Ton J Cleophas1, Aeilko H Zwinderman
1European Interuniversity College of Pharmaceutical Medicine, Lyon, France. ajm.cleophas@wxs.nl
Clinical Chemistry and Laboratory Medicine
|October 13, 2009
Summary
The diagnostic odds ratio (DOR) accounts for the negative correlation between sensitivity and specificity in meta-analyses. This method offers advantages in pooling diagnostic test accuracy data, improving reliability.
Area of Science:
- Medical diagnostic research
- Meta-analysis methodology
- Biostatistics
Background:
- Diagnostic reviews often pool sensitivity and specificity data.
- Pooling is problematic due to the strong negative correlation between sensitivity and specificity, leading to overestimation.
- The diagnostic odds ratio (DOR) is proposed to address this issue.
Purpose of the Study:
- To review the advantages and limitations of the diagnostic odds ratio (DOR).
- To explore the application of DOR in meta-analyses of diagnostic test accuracy.
Main Methods:
- Systematic review of 44 previously published diagnostic studies.
- Analysis of the properties and applicability of the diagnostic odds ratio.
Main Results:
- DORs adjust for negative curvilinear correlations between sensitivity and specificity.
- DORs account for heterogeneity due to varying thresholds across studies.
- The DOR model can be extended with covariates for between-study differences.
- Limitations include DOR being a summary estimate and not accounting for study magnitude.
Conclusions:
- Sensitivity and specificity in diagnostic studies exhibit a negative curvilinear correlation.
- This correlation must be considered in meta-analyses of diagnostic test accuracy.
- Diagnostic odds ratios (DORs) are appropriate for pooling such data.
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