Advancements and challenges in network meta-analysis of diagnostic test accuracy_Chinese Journal of Evidence-Based Medicine

Authors：

ZHENG Qingyong ^1,2 , ZHOU Yongjia ^1,2,3 , XU Jianguo ^1,2 , GAO Ya ^1,2 , LIU Ming ^1,2 , GE Long ^2,4,5 , LI Lun ^6,7 , WANG Quan ⁸ , HUANG Yan ⁹ , LI Jiang ¹⁰ ,  ZHANG Junhua ¹¹ ,  TIAN Jinhui ^1,2

1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
2. Key Laboratory of Evidence-based Medicine of Gansu Province, Lanzhou 730000, P. R. China;
3. School of Nursing, Gansu University of Chinese Medicine, Lanzhou 730000, P. R. China;
4. Evidence-Based Social Sciences Research Centre, Lanzhou University, Lanzhou 730000, P. R. China;
5. Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
6. Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China;
7. Clinical Research Center of Hunan Province, Changsha 410011, P. R. China;
8. Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi’an 710068, P. R. China;
9. China Medical University, Shenyang 110122, P. R. China;
10. National Cancer Center/National Cancer Clinical Medical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P. R. China;
11. Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;

Corresponding author：

ZHANG Junhua, Email: zjhtcm@163.com; TIAN Jinhui, Email: tjh996@163.com

Keywords：

Diagnostic test; Network meta-analysis; Methodology; Research progress

DOI：

10.7507/1672-2531.202409119

Video：

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Abstract Full text Figures/Tables Video References Cited by

This study comprehensively reviews the theoretical foundations, historical development, practical applications, and potential challenges of network meta-analysis of diagnostic test accuracy (DTA-NMA). DTA-NMA, as a method for evaluating and comparing the accuracy of different diagnostic tests, demonstrates its unique value in improving diagnostic accuracy and optimizing treatment strategies by integrating direct and indirect evidence, providing crucial support for clinical decision-making. However, despite significant progress in methodology and practice, DTA-NMA still faces multiple challenges in implementation, including enhancing research transparency, integrating diverse evidence, accurately assessing bias risks, presenting and interpreting results, and evaluating evidence quality. In the future, further refinement of reporting standards and evidence grading specific to DTA-NMA research will be crucial for the development of this field, facilitating evidence-based efficient medical decision-making and ultimately improving patient outcomes. This study aims to provide scholars conducting DTA-NMA research with reflection and insights to promote the steady development of this field.

1.	Veroniki AA, Tsokani S, Agarwal R, et al. Diagnostic test accuracy network meta-analysis methods: a scoping review and empirical assessment. J Clin Epidemiol, 2022, 146: 86-96.
2.	陆瑶, 杨秋玉, 刘雅菲, 等. 如何制作诊断试验准确性比较的系统评价与Meta分析. 中国循证医学杂志, 2022, 22(11): 1339-1347.
3.	Dehmoobad Sharifabadi A, Leeflang M, Treanor L, et al. Comparative reviews of diagnostic test accuracy in imaging research: evaluation of current practices. Eur Radiol, 2019, 29(10): 5386-5394.
4.	Yang B, Olsen M, Vali Y, et al. Study designs for comparative diagnostic test accuracy: A methodological review and classification scheme. J Clin Epidemiol, 2021, 138: 128-138.
5.	Tian J, Gao Y, Zhang J, et al. Progress and challenges of network meta-analysis. J Evid Based Med, 2021, 14(3): 218-231.
6.	杨秋玉, 陆瑶, 田晨, 等. 诊断试验准确性比较研究: 研究设计. 中国循证医学杂志, 2022, 22(6): 739-744.
7.	Ma X, Lian Q, Chu H, et al. A Bayesian hierarchical model for network meta-analysis of multiple diagnostic tests. Biostatistics, 2018, 19(1): 87-102.
8.	Nyaga VN, Aerts M, Arbyn M. ANOVA model for network meta-analysis of diagnostic test accuracy data. Stat Methods Med Res, 2018, 27(6): 1766-1784.
9.	N Nyaga V, Arbyn M, Aerts M. Beta-binomial analysis of variance model for network meta-analysis of diagnostic test accuracy data. Stat Methods Med Res, 2018, 27(8): 2554-2566.
10.	. Rücker G. Network meta-analysis of diagnostic test accuracy studies. In: Diagnostic meta-analysis. Springer, Cham, 2018.
11.	Reitsma JB, Moons KG, Bossuyt PM, et al. Systematic reviews of studies quantifying the accuracy of diagnostic tests and markers. Clin Chem, 2012, 58(11): 1534-1545.
12.	高亚, 孙凤, 武珊珊, 等. 网络Meta分析研究进展系列(五): 诊断试验准确性网络Meta分析. 中国循证心血管医学杂志, 2020, 12(10): 1161-1165.
13.	Bucher HC, Guyatt GH, Griffith LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol, 1997, 50(6): 683-691.
14.	Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16): 2313-2324.
15.	Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med, 2003, 138(1): W1-12.
16.	Purkayastha S, Athanasiou T, Tekkis PP, et al. Magnetic resonance colonography vs computed tomography colonography for the diagnosis of colorectal cancer: an indirect comparison. Colorectal Dis, 2007, 9(2): 100-111.
17.	Song F, Harvey I, Lilford R. Adjusted indirect comparison may be less biased than direct comparison for evaluating new pharmaceutical interventions. J Clin Epidemiol, 2008, 61(5): 455-463.
18.	刘关键, 吴泰相. 诊断性试验的Meta分析——SROC曲线法介绍. 中国循证医学杂志, 2003, (1): 41-44.
19.	滕芬. 住院癌症患者自杀风险因素与自杀意念的关系及预防干预策略. 武汉: 华中科技大学, 2020.
20.	张天嵩, 熊茜. 网络Meta分析在R软件中的实现. 循证医学, 2012, 12(3): 185-188.
21.	曾宪涛, 曹世义, 孙凤, 等. Meta分析系列之六: 间接比较及网状分析. 中国循证心血管医学杂志, 2012, 4(5): 399-402.
22.	曾宪涛, 徐畅, 张超, 等. 网状Meta分析在Stata软件中的实现. 中国循证医学杂志, 2013, 13(11): 1387-1391.
23.	张家华, 葛龙, 田金徽, 等. PET/CT和CT诊断宫颈癌腹主动脉淋巴结转移间接比较的Meta分析. 兰州大学学报(医学版), 2015, 41(1): 34-42.
24.	邓惠尹. 脓毒症相关脑功能障碍动物模型的建立及生物标志物分析. 长沙: 中南大学, 2023.
25.	吴景玲, 潘蓓, 葛龙, 等. ANOVA模型实现贝叶斯方法的诊断试验准确性网状Meta分析. 中国循证医学杂志, 2017, 17(9): 1111-1116.
26.	徐雪滢. 基于Beta分布的诊断性试验三元网状Meta分析模型的构建及应用研究. 沈阳: 中国医科大学, 2021.
27.	田金徽, 葛龙, 赵晔, 等. 网状Meta分析优先报告条目: PRISMA扩展声明解读. 中国药物评价, 2015, (5): 266-272.
28.	张永刚, 杨乐天, 杨鑫, 等. 诊断准确性试验的系统评价/Meta分析报告规范(PRISMA-DTA)的解读. 中国循证医学杂志, 2018, 18(9): 1007-1016.
29.	林丽玉, 许丽春, 张鑫, 等. 7种营养筛查工具对癌症患者营养筛查准确性的网状Meta分析. 护理学杂志, 2022, 37(12): 92-96.
30.	郑晓娜, 陈秋华, 邵庭芳, 等. 9种吞咽障碍筛查量表准确性的网状Meta分析. 中华护理杂志, 2019, 54(10): 1561-1566.
31.	吴景玲, 葛龙, 张俊华, 等. 多个诊断性试验准确性的比较: 网状Meta分析方法介绍. 中国循证医学杂志, 2017, 17(8): 987-992.
32.	Trikalinos TA, Hoaglin DC, Small KM, et al. Methods for the joint meta-analysis of multiple tests. Res Synth Methods, 2014, 5(4): 294-312.
33.	Menten J, Lesaffre E. A general framework for comparative Bayesian meta-analysis of diagnostic studies. BMC Med Res Methodol, 2015, 15: 70.
34.	Hoyer A, Kuss O. Meta-analysis for the comparison of two diagnostic tests to a common gold standard: a generalized linear mixed model approach. Stat Methods Med Res, 2018, 27(5): 1410-1421.
35.	Owen RK, Cooper NJ, Quinn TJ, et al. Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for health care policy and decision-making. J Clin Epidemiol, 2018, 99: 64-74.
36.	Lian Q, Hodges JS, Chu H. A Bayesian hierarchical summary receiver operating characteristic model for network meta-analysis of diagnostic tests. J Am Stat Assoc, 2019, 114(527): 949-961.
37.	Korevaar DA, Hooft L, Askie LM, et al. Facilitating prospective registration of diagnostic accuracy studies: a STARD initiative. Clin Chem, 2017, 63(8): 1331-1341.
38.	田晨, 杨秋玉, 赖鸿皓, 等. 诊断性试验准确性比较研究. 中国循证医学杂志, 2022, 22(5): 590-594.
39.	李响. X线诊断痛风性关节炎患者的临床诊断准确性探讨. 影像研究与医学应用, 2022, 6(17): 170-172.
40.	Agorastos T, Chatzistamatiou K, Katsamagkas T, et al. Primary screening for cervical cancer based on high-risk human papillomavirus (HPV) detection and HPV 16 and HPV 18 genotyping, in comparison to cytology. PLoS One, 2015, 10(3): e0119755.
41.	Carrara S, Anderloni A, Jovani M, et al. A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses. Dig Liver Dis, 2016, 48(1): 49-54.
42.	Sheridan K, Kreulen C, Kim S, et al. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc, 2015, 23(9): 2645-2650.
43.	Schaefgen B, Mati M, Sinn HP, et al. Can routine imaging after neoadjuvant chemotherapy in breast cancer predict pathologic complete response. Ann Surg Oncol, 2016, 23(3): 789-795.
44.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
45.	Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
46.	邬兰, 张永, 曾宪涛. QUADAS-2在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 2013, 32(3): 201-208.
47.	黄玉香, 沈建通, 刘雨今. 诊断试验准确性比较研究偏倚风险评价工具QUADAS-C解读. 中国循证医学杂志, 2022, 22(9): 1108-1116.
48.	Veroniki AA, Tricco AC, Watt J, et al. Rapid antigen-based and rapid molecular tests for the detection of SARS-CoV-2: a rapid review with network meta-analysis of diagnostic test accuracy studies. BMC Med, 2023, 21(1): 110.
49.	袁晨璐, 焦彦霞, 魏育婷, 等. ICU患者压力性损伤风险评估工具准确性的网状Meta分析. 护理学杂志, 2023, 38(1): 59-63,68.
50.	McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA, 2018, 319(4): 388-396.
51.	Hutton B, Catalá-López F, Moher D. The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin (Barc), 2016, 147(6): 262-266.
52.	王琪, 王韵华, 赖鸿皓, 等. 网状Meta分析证据质量分级: CINeMA在线应用程序简介. 中国循证医学杂志, 2020, 20(9): 1111-1116.

1. Veroniki AA, Tsokani S, Agarwal R, et al. Diagnostic test accuracy network meta-analysis methods: a scoping review and empirical assessment. J Clin Epidemiol, 2022, 146: 86-96.
2. 陆瑶, 杨秋玉, 刘雅菲, 等. 如何制作诊断试验准确性比较的系统评价与Meta分析. 中国循证医学杂志, 2022, 22(11): 1339-1347.
3. Dehmoobad Sharifabadi A, Leeflang M, Treanor L, et al. Comparative reviews of diagnostic test accuracy in imaging research: evaluation of current practices. Eur Radiol, 2019, 29(10): 5386-5394.
4. Yang B, Olsen M, Vali Y, et al. Study designs for comparative diagnostic test accuracy: A methodological review and classification scheme. J Clin Epidemiol, 2021, 138: 128-138.
5. Tian J, Gao Y, Zhang J, et al. Progress and challenges of network meta-analysis. J Evid Based Med, 2021, 14(3): 218-231.
6. 杨秋玉, 陆瑶, 田晨, 等. 诊断试验准确性比较研究: 研究设计. 中国循证医学杂志, 2022, 22(6): 739-744.
7. Ma X, Lian Q, Chu H, et al. A Bayesian hierarchical model for network meta-analysis of multiple diagnostic tests. Biostatistics, 2018, 19(1): 87-102.
8. Nyaga VN, Aerts M, Arbyn M. ANOVA model for network meta-analysis of diagnostic test accuracy data. Stat Methods Med Res, 2018, 27(6): 1766-1784.
9. N Nyaga V, Arbyn M, Aerts M. Beta-binomial analysis of variance model for network meta-analysis of diagnostic test accuracy data. Stat Methods Med Res, 2018, 27(8): 2554-2566.
10. . Rücker G. Network meta-analysis of diagnostic test accuracy studies. In: Diagnostic meta-analysis. Springer, Cham, 2018.
11. Reitsma JB, Moons KG, Bossuyt PM, et al. Systematic reviews of studies quantifying the accuracy of diagnostic tests and markers. Clin Chem, 2012, 58(11): 1534-1545.
12. 高亚, 孙凤, 武珊珊, 等. 网络Meta分析研究进展系列(五): 诊断试验准确性网络Meta分析. 中国循证心血管医学杂志, 2020, 12(10): 1161-1165.
13. Bucher HC, Guyatt GH, Griffith LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol, 1997, 50(6): 683-691.
14. Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16): 2313-2324.
15. Bossuyt PM, Reitsma JB, Bruns DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med, 2003, 138(1): W1-12.
16. Purkayastha S, Athanasiou T, Tekkis PP, et al. Magnetic resonance colonography vs computed tomography colonography for the diagnosis of colorectal cancer: an indirect comparison. Colorectal Dis, 2007, 9(2): 100-111.
17. Song F, Harvey I, Lilford R. Adjusted indirect comparison may be less biased than direct comparison for evaluating new pharmaceutical interventions. J Clin Epidemiol, 2008, 61(5): 455-463.
18. 刘关键, 吴泰相. 诊断性试验的Meta分析——SROC曲线法介绍. 中国循证医学杂志, 2003, (1): 41-44.
19. 滕芬. 住院癌症患者自杀风险因素与自杀意念的关系及预防干预策略. 武汉: 华中科技大学, 2020.
20. 张天嵩, 熊茜. 网络Meta分析在R软件中的实现. 循证医学, 2012, 12(3): 185-188.
21. 曾宪涛, 曹世义, 孙凤, 等. Meta分析系列之六: 间接比较及网状分析. 中国循证心血管医学杂志, 2012, 4(5): 399-402.
22. 曾宪涛, 徐畅, 张超, 等. 网状Meta分析在Stata软件中的实现. 中国循证医学杂志, 2013, 13(11): 1387-1391.
23. 张家华, 葛龙, 田金徽, 等. PET/CT和CT诊断宫颈癌腹主动脉淋巴结转移间接比较的Meta分析. 兰州大学学报(医学版), 2015, 41(1): 34-42.
24. 邓惠尹. 脓毒症相关脑功能障碍动物模型的建立及生物标志物分析. 长沙: 中南大学, 2023.
25. 吴景玲, 潘蓓, 葛龙, 等. ANOVA模型实现贝叶斯方法的诊断试验准确性网状Meta分析. 中国循证医学杂志, 2017, 17(9): 1111-1116.
26. 徐雪滢. 基于Beta分布的诊断性试验三元网状Meta分析模型的构建及应用研究. 沈阳: 中国医科大学, 2021.
27. 田金徽, 葛龙, 赵晔, 等. 网状Meta分析优先报告条目: PRISMA扩展声明解读. 中国药物评价, 2015, (5): 266-272.
28. 张永刚, 杨乐天, 杨鑫, 等. 诊断准确性试验的系统评价/Meta分析报告规范(PRISMA-DTA)的解读. 中国循证医学杂志, 2018, 18(9): 1007-1016.
29. 林丽玉, 许丽春, 张鑫, 等. 7种营养筛查工具对癌症患者营养筛查准确性的网状Meta分析. 护理学杂志, 2022, 37(12): 92-96.
30. 郑晓娜, 陈秋华, 邵庭芳, 等. 9种吞咽障碍筛查量表准确性的网状Meta分析. 中华护理杂志, 2019, 54(10): 1561-1566.
31. 吴景玲, 葛龙, 张俊华, 等. 多个诊断性试验准确性的比较: 网状Meta分析方法介绍. 中国循证医学杂志, 2017, 17(8): 987-992.
32. Trikalinos TA, Hoaglin DC, Small KM, et al. Methods for the joint meta-analysis of multiple tests. Res Synth Methods, 2014, 5(4): 294-312.
33. Menten J, Lesaffre E. A general framework for comparative Bayesian meta-analysis of diagnostic studies. BMC Med Res Methodol, 2015, 15: 70.
34. Hoyer A, Kuss O. Meta-analysis for the comparison of two diagnostic tests to a common gold standard: a generalized linear mixed model approach. Stat Methods Med Res, 2018, 27(5): 1410-1421.
35. Owen RK, Cooper NJ, Quinn TJ, et al. Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for health care policy and decision-making. J Clin Epidemiol, 2018, 99: 64-74.
36. Lian Q, Hodges JS, Chu H. A Bayesian hierarchical summary receiver operating characteristic model for network meta-analysis of diagnostic tests. J Am Stat Assoc, 2019, 114(527): 949-961.
37. Korevaar DA, Hooft L, Askie LM, et al. Facilitating prospective registration of diagnostic accuracy studies: a STARD initiative. Clin Chem, 2017, 63(8): 1331-1341.
38. 田晨, 杨秋玉, 赖鸿皓, 等. 诊断性试验准确性比较研究. 中国循证医学杂志, 2022, 22(5): 590-594.
39. 李响. X线诊断痛风性关节炎患者的临床诊断准确性探讨. 影像研究与医学应用, 2022, 6(17): 170-172.
40. Agorastos T, Chatzistamatiou K, Katsamagkas T, et al. Primary screening for cervical cancer based on high-risk human papillomavirus (HPV) detection and HPV 16 and HPV 18 genotyping, in comparison to cytology. PLoS One, 2015, 10(3): e0119755.
41. Carrara S, Anderloni A, Jovani M, et al. A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses. Dig Liver Dis, 2016, 48(1): 49-54.
42. Sheridan K, Kreulen C, Kim S, et al. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc, 2015, 23(9): 2645-2650.
43. Schaefgen B, Mati M, Sinn HP, et al. Can routine imaging after neoadjuvant chemotherapy in breast cancer predict pathologic complete response. Ann Surg Oncol, 2016, 23(3): 789-795.
44. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
45. Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
46. 邬兰, 张永, 曾宪涛. QUADAS-2在诊断准确性研究的质量评价工具中的应用. 湖北医药学院学报, 2013, 32(3): 201-208.
47. 黄玉香, 沈建通, 刘雨今. 诊断试验准确性比较研究偏倚风险评价工具QUADAS-C解读. 中国循证医学杂志, 2022, 22(9): 1108-1116.
48. Veroniki AA, Tricco AC, Watt J, et al. Rapid antigen-based and rapid molecular tests for the detection of SARS-CoV-2: a rapid review with network meta-analysis of diagnostic test accuracy studies. BMC Med, 2023, 21(1): 110.
49. 袁晨璐, 焦彦霞, 魏育婷, 等. ICU患者压力性损伤风险评估工具准确性的网状Meta分析. 护理学杂志, 2023, 38(1): 59-63,68.
50. McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA, 2018, 319(4): 388-396.
51. Hutton B, Catalá-López F, Moher D. The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin (Barc), 2016, 147(6): 262-266.
52. 王琪, 王韵华, 赖鸿皓, 等. 网状Meta分析证据质量分级: CINeMA在线应用程序简介. 中国循证医学杂志, 2020, 20(9): 1111-1116.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesAdvancements and challenges in network meta-analysis of diagnostic test accuracy

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