A METAANALYTIC METHOD FOR SUMMARIZING DIAGNOSTIC-TEST PERFORMANCES - RECEIVER-OPERATING-CHARACTERISTIC SUMMARY POINT ESTIMATES
A METAANALYTIC METHOD FOR SUMMARIZING DIAGNOSTIC-TEST PERFORMANCES - RECEIVER-OPERATING-CHARACTERISTIC SUMMARY POINT ESTIMATES
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DOI：
10.1177/0272989x9301300313
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发表时间：
1993-07-01
影响因子：
3.6
通讯作者：
LITTENBERG, B
中科院分区：
文献类型：
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作者：
MIDGETTE, AS;STUKEL, TA;LITTENBERG, B
作者设计了一种荟萃分析方法来总结诊断测试性能，他们沿着描述了一个临床实例，其中他们分析了8项下肢近端深静脉血栓形成检测研究中实时超声检查的性能，这些研究是根据特定的纳入标准选择的。为了评估拟合概括受试者工作特征（ROC）曲线的证据，进行真阳性率（TPR）和假阳性率（FPR）估计值之间的相关性检验。高正相关性支持用ROC曲线总结研究。在缺乏这种相关性的情况下，同质性检验分别应用于敏感性（TPR）和特异性（TNR）的估计值，以评估研究之间的差异是否仅仅是由于偶然性。如果估计值是齐次的，则计算汇总点估计值和置信区间（CI）。作为最后一步，可以进行亚组分析，以评估TPR和FPR变异性的替代解释。在有或无静脉血栓形成症状的组内，TPR和FPR之间呈负相关，研究间具有同质性，对于有症状的患者，汇总TPR为0.97，95%CI为（0.94，0.99），汇总TNR为0.97（0.95，0.99）。对于无症状患者，汇总TPR为0.66（0.50，0.81），汇总TNR为0.96（0.90，0.99）。有症状与无症状患者TPR差异有统计学意义。没有证据表明测试参考偏倚或缺乏对测试结果的独立解释会影响这些结果。它的结论是，这种荟萃分析方法代表了一种定量的方法来总结诊断测试的性能。它提供了在拟合概括ROC曲线、计算概括点估计值或报告TPR和TNR范围的方法中作出决定的标准。当TPR和FPR不呈正相关，但指数检验特征在研究中是同质的时，引入了一个汇总点估计。该方法还允许检查测试性能特征差异的替代解释，例如患者亚组之间的差异或研究设计中的偏倚。
The authors have devised a meta-analytic method to summarize diagnostic test performances, which they describe along with a clinical example wherein they analyze the performances of real-time ultrasonography in eight studies of the detection of proximal deep venous thrombosis of the lower extremity, selected on the basis of specific inclusion criteria. To evaluate the evidence for fitting a summary receiver operating characteristic (ROC) curve, a test of correlation between the estimates of true-positive rate (TPR) and false-positive rate (FPR) is performed. A high positive correlation argues for summarizing the studies with an ROC curve. In the absence of such correlation, a test of homogeneity is applied separately to the estimates of sensitivity (TPR) and specificity (TNR) to evaluate whether differences among studies are due to chance alone. If the estimates are homogeneous, a summary point estimate and confidence intervals (CIs) are calculated. As a final step, subgroup analyses can be performed to assess alternative explanations of variability in TPR and FPR. Within groups defined by the presence or absence of symptoms of venous thrombosis, a negative correlation between TPR and FPR and homogeneity among studies were found. For symptomatic patients, the summary TPR was 0.97 with a 95% CI of (0.94, 0.99) and the summary TNR was 0.97 (0.95, 0.99). For asymptomatic patients, the summary TPR was 0.66 (0.50, 0.81), and the summary TNR was 0.96 (0.90, 0.99). The difference in TPR between symptomatic and asymptomatic patients was statistically significant. There was no evidence that test referral bias or lack of independent interpretation of test results influenced these findings. It is concluded that this meta-analytic method represents a quantitative approach to summarizing the performances of diagnostic tests. It provides criteria for deciding among the approaches of fitting a summary ROC curve, calculating a summary point estimate, or reporting ranges of TPRs and TNRs. A summary point estimate is introduced for use when TPR and FPR are not positively correlated but index test characteristics are homogeneous among studies. This method also allows examination of alternative explanations of differences in test performance characteristics such as differences among subgroups of patients or biases in study design.