Exploring sources of heterogeneity in systematic reviews of diagnostic tests

Lijmer, Jeroen G.; Bossuyt, Patrick M.; Heisterkamp, S. H.

doi:10.1002/sim.1185

Cited by 390 publications

(319 citation statements)

References 31 publications

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“…Paired forest plots for displaying sensitivity and specificity were constructed using the format described by Leeflang et al 22 with the modifications proposed by Hyde et al 23 Stepwise multiple regression using SPSS for Windows version 10 (SPSS Inc., Chicago, Illinois) was also performed to determine the effect of verification bias and other study design factors on sensitivity and specificity. 18,24,25 Summary receiver operating characteristic (sROC) curves for the FOBT studies were constructed as previously described. [26][27][28][29] In this method, the sensitivity and false positivity are transformed into their logistic form (also called the logits) defined as the natural log of the positivity rate/(1-positivity rate).…”

Section: Methodsmentioning

confidence: 99%

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

Rosman

Korsten

2010

J GEN INTERN MED

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OBJECTIVES: There is controversy regarding the sensitivity of fecal occult blood tests (FOBT) for detecting colorectal cancer. Many of the published studies failed to correct for verification bias which may have increased the sensitivity. METHODS: A meta-analysis of published studies evaluating the sensitivity and specificity of chemical-based FOBT for colorectal cancer was performed. Studies were included if both cancer and control subjects underwent confirmatory testing. We also included studies that attempted to correct for verification bias by either performing colonoscopy on all subjects regardless of the FOBT result or by using longitudinal follow-up. We then compared the sensitivity, specificity, and other diagnostic characteristics of the studies that attempted to correct for verification (n=10) vs. those that did not correct for this bias (n=19). RESULTS: The pooled sensitivity of guaiac-based FOBT for colorectal cancer of studies without verification bias was significantly lower than those studies with this bias There was no significant difference in the area under the summary receiver operating characteristic curves. More sensitive chemical-based FOBT methods (e.g., Hemoccult® SENSA®) had a higher sensitivity but a lower specificity than standard guaiac methods. CONCLUSIONS: The sensitivity of guaiac-based FOBT for colorectal cancer has been overestimated as a result of verification bias. This test may not be sensitive enough to serve as an effective screening option for colorectal cancer.KEY WORDS: fecal occult blood; guaiac; colorectal cancer; summary receiver operating characteristic curve; meta-analysis.

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Section: Methodsmentioning

confidence: 99%

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

Rosman

Korsten

2010

J GEN INTERN MED

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“…With new developments in improving the methodology of diagnostic research [66], and pragmatic criteria developed to overcome limitations such as the absence of perfect reference tests [67], the quality and report of original diagnostic studies are expected to improve. Until then, meta-analysis is a reliable way to study the literature on the accuracy of diagnostic tests, evaluate its quality [68], and explore heterogeneity between results of original studies [69]. Ultimately, with improvements in the quality of original studies and meta-analytic techniques, meta-analyses may help with the design of therapeutic trials which use diagnostic tests to evaluate outcomes, and make necessary corrections in quantifying the true treatment benefit [8].…”

Section: Resultsmentioning

confidence: 99%

The true treatment benefit is unpredictable in clinical trials using surrogate outcome measured with diagnostic tests

Kassaï

Shah

Leizorovicza

et al. 2005

Journal of Clinical Epidemiology

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Background and Objectives-Clinical trials increasingly use results of diagnostic tests as surrogate outcomes. Our objective was to answer the following questions: (1) is the parameter measured by the reference standard a valid surrogate? (2) How does the tests accuracy influence the estimate of the treatment benefit on surrogate? (3) Is it possible to correct the measured treatment effect given by results of inaccurate tests?Methods and Setting-We reviewed the literature on asymptomatic deep venous thrombosis (DVT), detected by the reference standard and other imaging techniques, as surrogate for venous thromboembolism. The influence of test inaccuracy on the measurement of treatment benefit was calculated as a function of the patient baseline risk, the treatment effect model, and test performances.Results-We show that: (1) asymptomatic DVT is correlated with clinical outcomes but is yet to be established as a surrogate; (2) inaccurate diagnostic test underestimates the treatment effect on surrogate; (3) the prevalence of the disease, the treatment effect model, and the accuracy of the test and the reference standard used to evaluate it need to be known to correct this underestimation.Conclusion-Even when the surrogate end point is valid, without a reliable study of the diagnostic test we cannot quantify the true treatment effect.

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“…Pooled ORs were computed as the MantelHaenszel-weighted average of the ORs for all included studies. Heterogeneity was measured by the Cochran Q statistic (p <0.05) and quantified with the I 2 statistic [19]. The I 2 statistic describes the variation in the effect estimate that is attributable to heterogeneity across studies.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike most medications, BPs are not totally excreted by the kidneys but are deposited within the bones. Accumulated literature has suggested a possible link between the use of BPs and a rare adverse effect, ONJ [19]. Due to the rarity of the ONJ, most published studies were isolated single case or retrospective case series reports without appropriate controls [19,23].…”

Section: Discussionmentioning

confidence: 99%

“…Accumulated literature has suggested a possible link between the use of BPs and a rare adverse effect, ONJ [19]. Due to the rarity of the ONJ, most published studies were isolated single case or retrospective case series reports without appropriate controls [19,23]. The true impact of BPs on the incidence of ONJ at the population level has not been determined.…”

Section: Discussionmentioning

confidence: 99%

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Use of bisphosphonates and the risk of osteonecrosis among cancer patients: a systemic review and meta-analysis of the observational studies

Lee

Chan

Chang

et al. 2013

Support Care Cancer

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Purpose This study aims to systematically review observational studies evaluating the use of bisphosphonates (BPs) and risk of osteonecrosis of the jaw (ONJ) among cancer patients. Methods PubMed, Embase, and Cochrane Library were screened from database inception to Aug 2012. Two reviewers independently identified cohort and case-control studies evaluating the use of oral or intravenous (IV) BPs and the risk of ONJ and extracted the characteristics of the studies and risk estimates. Pooled estimates of odds ratios and 95 % confidence intervals were derived by random effects metaanalysis. Subgroup analyses were carried out according to patients' characteristics and route of BP use. ResultsWe identified eight studies, including 1,389 cases and 569,620 controls. Use of BPs was associated with a significantly increased risk of ONJ (odds ratio (OR) 4.25; 95 % confidence interval (CI) 3.67-5.36; I 2 =0 %). The summary OR was 4.22 (95 % CI 3.21-5.54; I 2 =0 %) for adjusted studies. IV BPs were associated with higher risk (OR 4.27; 95 % CI 3.38-5.40; I 2 =0 %) than oral BPs (OR 1.18; 95 % CI 0.89-1.56; I 2 =0 %). Hospital-based studies were associated with higher risk estimates than population-based studies. Conclusion The available evidence suggests that use of BPs in cancer patients is associated with a substantial risk for ONJ. Patients receiving IV BP are at the highest risk. It is important to assess oral health before initiating therapy and to avoid dental procedures during the active phase of intravenous BP therapy.Electronic supplementary material The online version of this article

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Exploring sources of heterogeneity in systematic reviews of diagnostic tests

Cited by 390 publications

References 31 publications

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

The true treatment benefit is unpredictable in clinical trials using surrogate outcome measured with diagnostic tests

Use of bisphosphonates and the risk of osteonecrosis among cancer patients: a systemic review and meta-analysis of the observational studies

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