Meta-analyses of studies of the diagnostic accuracy of laboratory tests: a review of the concepts and methods.

OBJECTIVE: To provide practicing pathologists and other laboratory professionals with the necessary background for reading and evaluating published reports of meta-analyses of studies of the diagnostic accuracy of laboratory tests. STUDY SELECTION: English language literature, 1980 to present, pertaining to the rationale, objectives, and interpretation of meta-analyses of randomized controlled trials, and meta-analyses of studies of the diagnostic accuracy of laboratory tests.
CONCLUSIONS: Meta-analysis has several applications in the investigation of the diagnostic accuracy of laboratory tests. It can improve the quality of future primary studies by drawing attention to the methodologic deficiencies of existing reports; it can identify reasons for the variation in the results of those reports; and it can generate valid summary estimates of the diagnostic accuracy of laboratory tests based on all completed investigations, providing that the available primary studies are of high scientific validity. Several statistical techniques for integrating data from reports on diagnostic test accuracy have either been developed or are under development, but meta-analysis is often limited by the poor quality of the primary studies and the effect of publication bias. Meta-analysis can evolve into a reliable tool for assessing the accuracy of laboratory tests if both investigators and editors strive to improve the quality of the primary studies and to reduce the extent of publication bias in this area of the literature.