Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;12(1):34-44.
doi: 10.1002/jrsm.1439. Epub 2020 Aug 12.

Graphical enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta-analysis of diagnostic test accuracy data

Amit Patel  1   2 , Nicola Cooper  2   3 , Suzanne Freeman  2   3 , Alex Sutton  2   3
Affiliations

Graphical enhancements to summary receiver operating characteristic plots to facilitate the analysis and reporting of meta-analysis of diagnostic test accuracy data

Amit Patel et al. Res Synth Methods. 2021 Jan.

Abstract

Diagnostic test accuracy (DTA) systematic reviews are conducted to summarize evidence on the accuracy of a diagnostic test including a critical evaluation of the primary studies. Where appropriate, the evidence is meta-analyzed to obtain pooled estimates of effectiveness.In this study, we reviewed and critiqued three DTA guidance documents with respect to the graphical presentation of DTA meta-analysis results. All three documents recommended the use of two forms of graphical presentation: (a) forest plots displaying meta-analysis results for sensitivity (ie, the true positive rate) and specificity (ie, true negative rate) separately, and (b) Summary Receiver Operating Characteristic (SROC) curve to provide a global summary of test performance. Two primary shortcomings were identified: (a) lack of incorporation of quality assessment results into the main analysis and; (b) ambiguity with which the contribution of individual studies is represented on SROC curves. In response, two alternative graphical approaches were developed: A quality assessment enhanced SROC plot which displays the results from individual studies in the meta-analysis with multiple indicators of quality assessed using QUADAS-2; and A percentage study weights enhanced SROC plot which accurately portrays the percentage contribution each study makes to the meta-analysis. The proposed enhanced SROC curves facilitate the exploration of DTA data, leading to a deeper understanding of the primary studies included in a DTA meta-analysis including identifying reasons for between study heterogeneity and why specific study results may be divergent. Both plots can easily be produced in the free online interactive application, MetaDTA (https://crsu.shinyapps.io/dta_ma/).

Keywords: diagnostic test accuracy; meta-analysis; received operating characteristic curves.

PubMed Disclaimer

References

REFERENCES

    1. Leeflang MM, Deeks JJ, Takwoingi Y, Macaskill P. Cochrane diagnostic test accuracy reviews. Syst Rev. 2013;2(1):82.
    1. Harbord RM, Deeks JJ, Egger M, Whiting P, Sterne JA. A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics. 2006;8(2):239-251.
    1. M. D. McInnes, D. Moher, B. D. Thombs, T. A. McGrath, P. M. Bossuyt, T. Clifford, J. F. Cohen, J. J. Deeks, C. Gatsonis, L. Hooft and others, "Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement," JAMA, vol. 319, no. 4, pp. 388-396, 2018.
    1. Macaskill P, Gatsonis C, Deeks J, Harbord R, Takwoingi Y. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, Version 0.9. 0. London: The Cochrane Collaboration; 2010.
    1. Freeman SC, Kerby CR, Patel A, Cooper NJ, Quinn T, Sutton AJ. Development of an interactive web-based tool to conduct and interrogate meta-analysis of diagnostic test accuracy studies: MetaDTA. BMC Med Res Methodol. 2019;19(1):81.

MeSH terms

LinkOut - more resources