Abstract
BackgroundSystematic reviews and meta-analyses of test accuracy studies are increasingly being recognised as central in guiding clinical practice. However, there is currently no dedicated and comprehensive software for meta-analysis of diagnostic data. In this article, we present Meta-DiSc, a Windows-based, user-friendly, freely available (for academic use) software that we have developed, piloted, and validated to perform diagnostic meta-analysis.ResultsMeta-DiSc a) allows exploration of heterogeneity, with a variety of statistics including chi-square, I-squared and Spearman correlation tests, b) implements meta-regression techniques to explore the relationships between study characteristics and accuracy estimates, c) performs statistical pooling of sensitivities, specificities, likelihood ratios and diagnostic odds ratios using fixed and random effects models, both overall and in subgroups and d) produces high quality figures, including forest plots and summary receiver operating characteristic curves that can be exported for use in manuscripts for publication. All computational algorithms have been validated through comparison with different statistical tools and published meta-analyses. Meta-DiSc has a Graphical User Interface with roll-down menus, dialog boxes, and online help facilities.ConclusionMeta-DiSc is a comprehensive and dedicated test accuracy meta-analysis software. It has already been used and cited in several meta-analyses published in high-ranking journals. The software is publicly available at .
Highlights
Systematic reviews and meta-analyses of test accuracy studies are increasingly being recognised as central in guiding clinical practice
If a particular study level co-variate is significantly associated with diagnostic accuracy, its co-efficient will have a low pvalue, and the ratio of dOR (rdOR) will give a measure of magnitude of the association
Meta-DiSc has comprehensive functionality for statistical pooling: a) It allows pooling of sensitivities, specificities, likelihood ratios (LRs) positive and LR negative each separately, using either
Summary
We illustrate the various procedures that Meta-DiSc implements in a case-study of ultrasound test in the diagnosis of uterine pathology [21,22]. Ultrasound measurement of the lining of the uterus (endometrium) can predict pathology such as endometrial hyperplasia (a precancerous condition) or cancer. The greater the thickness of endometrium, the more likely that the target condition is present. Various thresholds (such as 3, 4 or 5 mm etc) have been used to define a positive ultrasound result. A systematic review of test accuracy studies identified 57 studies. The information includes study identifiers, accuracy data,
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