Meta-analysis of diagnostic tests with imperfect reference standards

Walter, S. D., Irwig, L. and Glasziou, P. P. (1999) Meta-analysis of diagnostic tests with imperfect reference standards. Journal of Clinical Epidemiology, 52 10: 943-951. doi:10.1016/S0895-4356(99)00086-4

Author Walter, S. D.
Irwig, L.
Glasziou, P. P.
Title Meta-analysis of diagnostic tests with imperfect reference standards
Journal name Journal of Clinical Epidemiology   Check publisher's open access policy
ISSN 0895-4356
Publication date 1999-10
Sub-type Article (original research)
DOI 10.1016/S0895-4356(99)00086-4
Volume 52
Issue 10
Start page 943
End page 951
Total pages 9
Place of publication New York
Publisher Elsevier
Collection year 1999
Language eng
Subject C1
730305 Diagnostic methods
321202 Epidemiology
Abstract We present a method to estimate the summary receiver operating characteristic (SROC) curve for combining information on a diagnostic test from several different studies. Unlike previous methods that assume the reference standard to be error free, our approach allows for the possibility of errors in the reference standard, through use of a latent class model. The model provides estimates of the sensitivity and specificity of the diagnostic test and the case prevalence in each study; these parameters can then be used in a meta-analysis, for example, using the regression method proposed by Moses et al., of a measure of test discrimination on a measure of the diagnostic threshold, to fit the SROC. The method is illustrated with an example on Pap smears that shows how adjusting for imperfection in the reference standard typically reduces the scatter of data in the SROC plot, and tends to indicate better performance of the test than otherwise. (C) 1999 Elsevier Science Inc.
Keyword Public, Environmental & Occupational Health
Sensitivity And Specificity
Diagnostic Tests
Latent Class Model
Roc Curve
Disease Prevalence
Test Accuracy
External Standard
Gold Standard
Error Rates
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Public Health Publications
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 63 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 75 times in Scopus Article | Citations
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Created: Tue, 10 Jun 2008, 14:56:56 EST