METAANALYSES OF STUDIES OF THE DIAGNOSTIC-ACCURACY OF LABORATORY TESTS - A REVIEW OF THE CONCEPTS AND METHODS

Objective.-To provide practicing pathologists and other laboratory pro fessionals with the necessary background for reading and evaluating pu blished reports of meta-analyses of studies of the diagnostic accuracy of laboratory tests. Study Selection.-English language literature, 19 80 to present, pertaining to the rationale, objectives, and interpreta tion of meta-analyses of randomized controlled trials, and meta-analys es of studies of the diagnostic accuracy of laboratory tests. Conclusi ons.-Meta-analysis has several applications in the investigation of th e diagnostic accuracy of laboratory tests. It can improve the quality of future primary studies by drawing attention to the methodologic def iciencies of existing reports; it can identify reasons for the variati on 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 i ntegrating data from reports on diagnostic test accuracy have either b een developed or are under development, but meta-analysis is often lim ited by the poor quality of the primary studies and the effect of publ ication bias. Meta-analysis can evolve into a reliable tool for assess ing the accuracy of laboratory tests if both investigators and editors strive to improve the quality of the primary studies and to reduce th e extent of publication bias in this area of the literature.