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

BMJ 2006; 333 doi: (Published 24 August 2006) Cite this as: BMJ 2006;333:413
  1. Susan Mallett (susan.mallett{at}, medical statistician1,
  2. Jonathan J Deeks, professor of health statistics2,
  3. Steve Halligan, professor of gastrointestinal radiology4,
  4. Sally Hopewell, research scientist3,
  5. Victoria Cornelius, statistician5,
  6. Douglas G Altman, professor of statistics in medicine1
  1. 1 Centre for Statistics in Medicine, University of Oxford, Wolfson College, Oxford OX2 6UD,
  2. 2 Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT,
  3. 3 UK Cochrane Centre, Oxford OX2 7LG,
  4. 4 Department of Specialist Radiology, University College London, London NW1 2BU,
  5. 5 Drug Safety Research Unit, Southampton SO31 1AA
  1. Correspondence to: Susan Mallett
  • Accepted 31 May 2006


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.


  • Embedded ImageA list of the reviews assessed in detail is on

  • Contributors SHa, SHo, and VC completed duplicate data extraction to SM for a third of the data each. SM, JJD, and DGA contributed to analysis and presentation of data and drafting the article. SHo and SHa contributed to editing. SM and DGA are guarantors.

  • Funding SM, DGA, and VC are funded by Cancer Research UK. JJD is partially funded by a senior research fellowship in evidence synthesis from the UK Department of Health NCCRCD (National Coordinating Centre for Research Capacity Development). SHo is funded from the NHS research and development programme.

  • Competing interests None declared.

  • Ethical approval Not required.

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