BMJ  2006;333:413 (26 August), doi:10.1136/bmj.38895.467130.55 (published 18 July 2006)

Research

Systematic reviews of diagnostic tests in cancer: review of methods and reporting

Susan Mallett, medical statistician1, Jonathan J Deeks, professor of health statistics2, Steve Halligan, professor of gastrointestinal radiology4, Sally Hopewell, research scientist3, Victoria Cornelius, statistician5, Douglas G Altman, professor of statistics in medicine1

1 Centre for Statistics in Medicine, University of Oxford, Wolfson College, Oxford OX2 6UD, 2 Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, 3 UK Cochrane Centre, Oxford OX2 7LG, 4 Department of Specialist Radiology, University College London, London NW1 2BU, 5 Drug Safety Research Unit, Southampton SO31 1AA

Correspondence to: Susan Mallett susan.mallett{at}cancer.org.uk

Abstract

Objectives To assess the methods and reporting of systematic reviews of diagnostic tests.

Data sources Systematic searches of Medline, Embase, and five other databases identified reviews of tests used in patients with cancer. Of these, 89 satisfied our inclusion criteria of reporting accuracy of the test compared with a reference test, including an electronic search, and published since 1990.

Review methods All reviews were assessed for methods and reporting of objectives, search strategy, participants, clinical setting, index and reference tests, study design, study results, graphs, meta-analysis, quality, bias, and procedures in the review. We assessed 25 randomly selected reviews in more detail.

Results 75% (67) of the reviews stated inclusion criteria, 49% (44) tabulated characteristics of included studies, 40% (36) reported details of study design, 17% (15) reported on the clinical setting, 17% (15) reported on the severity of disease in participants, and 49% (44) reported on whether the tumours were primary, metastatic, or recurrent. Of the 25 reviews assessed in detail, 68% (17) stated the reference standard used in the review, 36% (9) reported the definition of a positive result for the index test, and 56% (14) reported sensitivity, specificity, and sample sizes for individual studies. Of the 89 reviews, 61% (54) attempted to formally synthesise results of the studies and 32% (29) reported formal assessments of study quality.

Conclusions Reliability and relevance of current systematic reviews of diagnostic tests is compromised by poor reporting and review methods.


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