Editing Meta-analysis (section)

====Diagnostic test accuracy meta-analysis====

Diagnostic test accuracy (DTA) meta-analyses differ methodologically from those assessing intervention effects, as they aim to jointly synthesize pairs of sensitivity and specificity values. These parameters are typically analyzed using hierarchical models that account for the correlation between them and between-study heterogeneity. Two commonly used models are the '''bivariate random-effects model''' and the '''hierarchical summary receiver operating characteristic (HSROC) model'''. These approaches are recommended by the ''Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy'' and are widely used in reviews of screening tests, imaging tools, and laboratory diagnostics.<ref name="Reitsma2005">Reitsma JB, Glas AS, Rutjes AWS, Scholten RJPM, Bossuyt PMM, Zwinderman AH (2005). Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. ''J Clin Epidemiol''. 58(10):982–990. doi:[https://doi.org/10.1016/j.jclinepi.2005.02.022 10.1016/j.jclinepi.2005.02.022]</ref><ref name="Rutter2001">Rutter CM, Gatsonis CA (2001). A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. ''Stat Med''. 20(19):2865–84. doi:[https://doi.org/10.1002/sim.942 10.1002/sim.942]</ref><ref name="CochraneDTA">McInnes MDF, Moher D, Thombs BD, et al. Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. ''JAMA''. 2018;319(4):388–396. doi:[https://doi.org/10.1001/jama.2017.19163 10.1001/jama.2017.19163]</ref>

Beyond the standard hierarchical models, other approaches have been developed to address various complexities in diagnostic accuracy synthesis. These include methods that incorporate differences in threshold effects, account for covariates through meta-regression, or improve applicability by considering test setting and clinical variation. Some frameworks aim to adapt the synthesis to reflect intended use conditions more directly. These extensions are part of an evolving body of methodology that reflects growing experience in the field and increasing demands from clinical and policy decision-makers.<ref name="Deeks2020">Deeks JJ, Takwoingi Y. Two decades of progress in test accuracy systematic reviews: Managing meta-analytical complexity. ''J Clin Epidemiol''. 2020;122:92–102. doi:[https://doi.org/10.1016/j.jclinepi.2020.03.003 10.1016/j.jclinepi.2020.03.003]</ref>