Diagnostic Meta-Analysis: A Useful Tool for Clinical Decision-Making

✍ Scribed by Giuseppe Biondi-Zoccai (editor)

• Publisher: Springer
• Year: 2018
• Tongue: English
• Leaves: 320
• Edition: 1st ed. 2018
• Category: Library

✦ Synopsis

This book is the first exclusively devoted to the systematic synthesis of diagnostic test accuracy studies. It builds upon the major recent developments in reporting standards, search methods, and, in particular, statistical tools specifically devoted to diagnostic studies. In addition, it borrows extensively from the latest advances in systematic reviews and meta-analyses of intervention studies. After a section dedicated to methods for designing reviews, synthesizing evidence and appraising inconsistency in research, the application of these approaches is demonstrated in the context of case studies from various clinical disciplines.

Diagnosis is central in medical decision-making, and in many other fields of human endeavor, such as education and psychology. The plurality of sources of evidence on diagnostic test accuracy poses a huge challenge for practitioners and researchers, as do the multiple dimensions of evidence validity, which include sensitivity, specificity, predictive values, and likelihood ratios.

This book offers an invaluable resource for anyone aiming to improve decision-making processes in diagnosis, classification or risk prognostication, from epidemiologists to biostatisticians, radiologists, laboratory physicians and graduate students, as any physician interested in refining his methodological skills in clinical diagnosis.

✦ Table of Contents

Foreword
Preface
Contents
Contributors
Part I
1: Introduction to Clinical Diagnosis
1.1 Index Test
1.2 Reference Test
1.3 Dimensions of Diagnostic Accuracy
References
2: The Evidence Hierarchy
References
3: Peculiarities of Diagnostic Test Accuracy Studies
3.1 Introduction
3.2 Methodological Issues and Sources of Bias
3.3 Dimensions of Diagnostic Accuracy
Appendix
References
4: Meta-Analyses of Clinical Trials Versus Diagnostic Test Accuracy Studies
4.1 Introduction
4.2 Meta-Analysis of Clinical Trials
4.2.1 Fixed and Random Effects Models
4.2.2 Funnel Plot
4.2.3 Sources of Heterogeneity in Meta-Analyses of Clinical Trials
4.2.4 Network Meta-Analysis
4.3 Meta-Analysis of Diagnostic Test Accuracy Studies
4.3.1 Types of Data and of Measures of Test Accuracy
4.3.2 Models
References
Part II
5: Designing the Review
5.1 Chapter Introduction
5.1.1 Body of the Protocol
5.1.2 Title
5.2 Background of the Systematic Review
5.3 Objectives
5.4 Methodology
5.4.1 Registration
5.4.2 PIRO Question
5.4.2.1 Description of the Population
5.4.2.2 Description of the Target Condition
5.4.2.3 Description of the Index Test
5.4.2.4 Description of the Standard Test
5.4.2.5 Description of the Outcomes
5.4.3 Search Methods
5.4.3.1 Databases
5.4.3.2 Other Resources
5.4.4 Eligibility Criteria
5.4.4.1 Type of Studies
5.4.4.2 Participants
5.4.4.3 Target Condition
5.4.4.4 Index Test: Technical Aspects
5.4.4.5 Reference or Standard Test
5.4.5 Data Collection Plan
5.4.5.1 Tables
5.4.6 Risk of Bias and Quality Assessment
5.4.7 Statistical Analysis Plan
5.5 Results
5.5.1 Search Results
5.5.2 Findings
5.6 Discussion
5.6.1 Summary of the Results
5.6.2 Limitations
5.6.3 Applications
5.7 Conclusion
5.7.1 Implication for Practice
5.7.2 Implication for Research
References
6: Registering the Review
6.1 Introduction
6.2 The Need for Registration
6.3 Options for Registration
6.4 Reviews of Diagnostic Accuracy Studies in PROSPERO
6.5 Registering a Review of Diagnostic Accuracy Studies on PROSPERO
6.5.1 Administrative Fields
6.5.2 Methods Fields
6.5.2.1 Review Question and Title
6.5.2.2 Searches
6.5.2.3 Condition, PICO, Context
6.5.2.4 Data Extraction
6.5.2.5 Quality Assessment
6.5.2.6 Data Synthesis and Subgroup Analyses
6.5.3 Dissemination
6.6 Practicalities of Registration
References
7: Searching for Diagnostic Test Accuracy Studies
7.1 Introduction
7.2 Searching for Diagnostic Test Accuracy Systematic Reviews
7.3 Searching for DTA Studies to Populate a Diagnostic Test Accuracy Review
7.3.1 Resources
7.4 Searching Bibliographic Databases Such as MEDLINE and Embase
7.4.1 Search Strategies
7.5 Managing References/Libraries
7.6 Updating Literature Searches
7.7 Current Awareness
7.8 Documenting the Search
7.9 Quality Assessment of the Search
7.10 Keeping Up to Date
7.11 Summary
References
8: Abstracting Evidence
8.1 Introduction
8.2 Collection of Review Data
8.3 Collection of Study Data
8.4 Troubleshooting
References
9: Appraising Evidence
9.1 Introduction
9.2 Source of Bias in Diagnostic Test Accuracy Studies
9.3 Critical Appraisal of a Diagnostic Test
9.4 Tool for the Reporting of Diagnostic Accuracy Studies: The STARD Statement
9.5 Tool to Assess the Quality of Diagnostic Accuracy Studies: QUADAS-2
9.6 Assessing the Quality of Evidence: The GRADE Approach
References
10: Synthesizing Evidence
10.1 Introduction
10.2 The SROC Curve
10.3 The Hierarchical Model
10.4 The Bivariate Model
10.4.1 Other Bivariate Models
10.5 Univariate Approaches
References
11: Appraising Heterogeneity
11.1 Introduction
11.1.1 Structure of the Chapter
11.1.2 Illustrating Example Meta-analysis
11.2 Sources of Bias and Variation
11.2.1 Sources in Different Dimensions of Diagnostic Studies
11.2.2 Effect of Variation and Bias on the Results
11.3 Visualization of the Variability
11.3.1 The ROC Plot
11.3.2 The Coupled Forest Plot
11.3.3 Cross-Hairs Plot
11.3.4 The Funnel Plot
11.4 Judging the Variability
11.4.1 The Cochran’ Q Test
11.4.2 Tests for Funnel Plot Asymmetry
11.5 Measuring the Variability
11.5.1 The I2 Index
11.5.2 The τ2 Parameter
11.5.3 The Prediction Ellipse
11.6 Attributing the Variability to Different Thresholds
11.7 Exploring the Different Sources of Variability
11.7.1 Fixed Versus Random Effects Models
11.7.2 Comparison of the Bivariate Model and the HSROC Approach
11.7.3 The Bivariate Model
11.7.4 The HSROC Model
11.7.5 Model Selection
11.7.6 Modifications of the Bivariate Model and the HSROC Approach
11.8 Further Issues with Heterogeneity
11.8.1 Bayesian Methods
11.8.2 Multiple Thresholds
11.8.3 Reference Standard Bias
11.8.4 Explicit Consideration of the Prevalence
11.8.5 Few Studies and Sparse Data
11.8.6 Individual Patient Data
11.8.7 Non-evaluable Index Test Results
11.8.8 Further Accuracy Measures
Reference
12: Statistical Packages for Diagnostic Meta-­Analysis and Their Application
12.1 Introduction
12.1.1 Overview of Software Packages
12.2 Sample Workflow in R
12.2.1 Importing Data Into R
12.2.2 Calculating Summary Statistics for Each Study
12.2.3 Graphical Techniques
12.2.4 Fitting the Bivariate Model
12.2.5 Fitting the Bivariate Model Without Covariates
12.2.6 SROC Curves
12.2.7 The Bivariate Model with Covariates
12.2.8 Fitting Strategies for Advanced Models
12.3 Discussion
12.3.1 SROC Models
12.3.1.1 Moses-Littenberg SROC Approach
12.3.1.2 Software for Current SROC Approaches
12.3.2 Multiple Thresholds
12.3.3 The Right Tool for the Job
References
13: Network Meta-Analysis of Diagnostic Test Accuracy Studies
13.1 Introduction
13.1.1 Network Meta-Analysis
13.1.2 Diagnostic Test Accuracy Studies
13.2 Network Meta-Analysis: Differences Between Diagnostic Tests and Interventions
13.2.1 Diagnostic Perspective: NMA of DTA Studies as Pairwise Multivariate Meta-Analysis
13.2.2 Prognostic Perspective: NMA of DTA Studies as NMA of Diagnostic Odds Ratios
13.3 Approaches for Comparing Multiple Diagnostic Tests
13.3.1 Separate Meta-Analyses
13.3.1.1 Special Case: Separate Meta-Analyses for Multiple Thresholds
13.3.2 Meta-Regression with Type of Test as a Covariate
13.3.3 Multivariate Meta-Analysis: Contrast-Based vs Arm-Based Approach
13.4 Existing Approaches to Meta-Analysis of Multiple DTA Studies
13.4.1 The Cochrane Handbook for DTA Reviews
13.4.1.1 Comparing Two Tests Between Studies
13.4.1.2 Comparing Two Tests Within Studies
13.4.2 The Approach by Trikalinos et al.
13.4.2.1 The Case of Two Tests
13.4.2.2 The Case of Three or More Tests
13.4.3 The Approach by Menten and Lesaffre
13.4.3.1 Model 1: Standard Bivariate Model
13.4.3.2 Model 2: Meta-Analysis Based on Direct Comparisons
13.4.3.3 Model 3: Meta-Analysis Based on Direct and Indirect Comparisons
13.4.3.4 Models 4 and 5
13.4.4 The Approach by Dimou et al.
13.4.5 The Approach by Hoyer and Kuss
13.4.6 Two Approaches by Nyaga et al.
13.4.6.1 Two-Stage Model Based on Logit Transformation
13.4.6.2 Beta-Binomial Model
13.4.7 Multivariate Meta-Analysis
13.4.8 Other Potential Research Questions
13.5 Discussion
References
14: Transition to Intervention Meta-Analysis
14.1 Introduction
14.2 Trials and Their Outcomes
14.3 Making Sense of the Data
References
15: Updating Diagnostic Test Accuracy Systematic Reviews: Which, When, and How Should They Be Updated?
15.1 Introduction
15.2 Which SR Should Be Updated?
15.3 When Should a SR Be Updated?
15.4 How Should a SR Be Updated?
15.5 Case Study
References
Part III
16: Diagnostic Meta-Analysis: Case Study in Endocrinology
16.1 Introduction
16.2 The Case Study 1: Comparison of the Diagnostic Value of Core-Needle and Fine-Needle Aspiration Biopsies of Thyroid Lesions
16.2.1 Background
16.2.2 Methods
16.2.2.1 Inclusion and Exclusion Criteria
16.2.2.2 The Data Synthesis
16.2.3 Results
16.2.4 Discussion
16.3 The Case Study 2: Sonographic Markers of Malignancy—Report on the Diagnostic Meta-Analysis
16.3.1 Background
16.3.2 Materials and Methods
16.3.2.1 Inclusion and Exclusion Criteria
16.3.2.2 The Data Synthesis
16.3.3 Results
16.3.3.1 Calculations for Particular Markers of Malignancy
Microcalcifications
Hypoechogenicity
16.3.3.2 Irregular Margins
16.3.3.3 Elastography
16.3.3.4 “Taller than Wide”
16.3.3.5 Halo Absence
16.3.3.6 Color Doppler Examination
16.3.3.7 Power Doppler: Pattern 3 Flow (Intensive Central with Lower Peripheral Blood Flow)
16.3.4 Discussion
References
17: Diagnostic Meta-Analysis: Case Study in Gastroenterology
17.1 Introduction
17.2 Background
17.3 Inclusion and Exclusion Criteria
17.4 Choosing the Best Meta-Meter
17.5 Duplicate Cohorts
17.6 Direct Versus Indirect Comparisons
17.7 Other Considerations
17.7.1 Fixed Versus Random Effects
17.7.2 Search Strategy
17.7.3 Screening Articles
17.7.4 Quality Assessment
References
18: Diagnostic Meta-Analysis: Case Study in Oncology
18.1 Cancer Epidemiology
18.1.1 Cancer Mortality
18.1.2 Cancer Survival
18.2 Importance of Diagnostic Test Accuracy (DTA) Systematic Reviews and Meta-Analysis as a Methodological Tool for Improving Clinical Management in Oncology
18.3 Current Quality Status of Diagnostic Systematic Reviews and Meta-Analysis in Oncology
18.4 How to Overcome Limitations on Summary of Evidence of DTA Studies in Oncology
18.4.1 Quality Assessment of DTA Studies in Oncology
18.4.2 Strategies to Improve Quality of Reporting of DTA Studies in Oncology
References
19: Diagnostic Meta-Analysis: Case Study in Surgery
19.1 Introduction
19.2 Surgical Needs
19.2.1 Preoperative Diagnosis
19.2.2 Intraoperative Diagnosis
19.2.3 Postoperative Diagnosis
19.2.4 Surgical and Medical Pathology
19.2.5 Advances in Disease Imaging and Tissue Guidance
19.2.6 Awareness of New Devices Ranging from Operative Monitoring/Diagnostic Devices, to Stapling Instruments, and Surgical Robots
19.3 Paper Selection
19.3.1 Study Design Terms
19.3.2 Defining the Research Question
19.3.3 Establishing the Study Selection Criteria
19.3.4 Performing the Literature Search of the Topic
19.3.5 Study Features, Outcomes, and Quality Assessment
19.3.6 Data Extraction
19.4 Study Analysis
19.5 Typical Problems in Surgical Diagnostic Meta-Analysis
References
Part IV
20: Avenues for Further Research
20.1 Review of Existing Statistical Work on Diagnostic Meta-analysis
20.2 Advanced Methods of Diagnostic Meta-analysis
20.2.1 Model Robustness
20.2.2 Absence of Gold Standard Test: Identifiability and Conditional Dependence
20.3 Future Work and Direction
20.3.1 Combination of Aggregated Data and Individual Patient-­Level Data
20.3.2 Partial Verification Bias/No Gold Standard for Individual Patient-Level Data
References
21: Conclusion
References