Article type
Year
Abstract
Background: The diagnosis of a clinical condition is usually the first and more crucial step before initiating treatment. Diagnostic tests are routinely used for confirming or excluding a target condition. Although most diagnostic test accuracy (DTA) studies have focused on assessing a single index test, studies and systematic reviews are increasingly comparing the accuracy of multiple index tests to facilitate the selection of the best performing test(s) for patient care. For example, HPV DNA, HPV mRNA, and co-testing can be used for cervical cancer diagnosis. But which test is the most sensitive (or specific)? Since studies that directly compare test accuracy are not always available and comparisons between multiple tests constitute a network, DTA network meta-analysis (DTA-NMA) has been proposed.
Objectives: To identify and summarize the properties of DTA-NMA methods for comparing the accuracy of multiple diagnostic tests. To describe the network characteristics of empirical DTA-NMA studies.
Methods: We conducted a methodological review of statistical and empirical studies that performed, described, or evaluated a DTA-NMA of at least 3 diagnostic tests. We searched PubMed, JSTOR, and Web of Science. Studies of any design published in English were eligible. We also included relevant unpublished material. Several methods have been suggested for modelling DTA studies in a NMA, which vary in complexity. We will present the approaches together with a critique of their strengths and limitations and will identify gaps where methodology is lacking. We will present the characteristics of previously conducted DTA-NMAs, and the methods that have been applied. Quantitative data will be summarized using medians and interquartile ranges, while categorical data will be summarized using frequencies and percentages. We will use cervical cancer as a case study, to present an application of the DTA-NMA methods and to determine the most promising test (in terms of sensitivity and specificity) for use as the primary screening test for cervical cancer.
Results: We included 38 studies. Evaluations are ongoing and results will be ready by June 2020 for presentation at the Cochrane Colloquium.
Conclusions: Our study will provide a comprehensive overview of the methods for conducting a DTA-NMA, insight into the characteristics of DTA-NMA applications, and propose recommendations for appropriate use and reporting.
Patient or healthcare consumer involvement: While there has been no direct patient involvement in this study, well conducted and reported DTA meta-analyses influence patient care directly since they are used in decision-making and for developing guidelines. When alternative tests that can be used at the same point in the diagnostic pathway exist, studies that compare several tests and estimate differences in sensitivity and specificity are more informative than those that evaluate the accuracy of a single index test. Therefore, the comparison of multiple diagnostic tests using NMA-DTA can impact clinical decisions and patient health.
Objectives: To identify and summarize the properties of DTA-NMA methods for comparing the accuracy of multiple diagnostic tests. To describe the network characteristics of empirical DTA-NMA studies.
Methods: We conducted a methodological review of statistical and empirical studies that performed, described, or evaluated a DTA-NMA of at least 3 diagnostic tests. We searched PubMed, JSTOR, and Web of Science. Studies of any design published in English were eligible. We also included relevant unpublished material. Several methods have been suggested for modelling DTA studies in a NMA, which vary in complexity. We will present the approaches together with a critique of their strengths and limitations and will identify gaps where methodology is lacking. We will present the characteristics of previously conducted DTA-NMAs, and the methods that have been applied. Quantitative data will be summarized using medians and interquartile ranges, while categorical data will be summarized using frequencies and percentages. We will use cervical cancer as a case study, to present an application of the DTA-NMA methods and to determine the most promising test (in terms of sensitivity and specificity) for use as the primary screening test for cervical cancer.
Results: We included 38 studies. Evaluations are ongoing and results will be ready by June 2020 for presentation at the Cochrane Colloquium.
Conclusions: Our study will provide a comprehensive overview of the methods for conducting a DTA-NMA, insight into the characteristics of DTA-NMA applications, and propose recommendations for appropriate use and reporting.
Patient or healthcare consumer involvement: While there has been no direct patient involvement in this study, well conducted and reported DTA meta-analyses influence patient care directly since they are used in decision-making and for developing guidelines. When alternative tests that can be used at the same point in the diagnostic pathway exist, studies that compare several tests and estimate differences in sensitivity and specificity are more informative than those that evaluate the accuracy of a single index test. Therefore, the comparison of multiple diagnostic tests using NMA-DTA can impact clinical decisions and patient health.