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Diagnostic Meta-Analysis: Case Study in Oncology

  • Sulbaran Marianny
  • Sousa Afonso
  • Bustamante-Lopez Leonardo
Chapter

Abstract

Cancer represents a major public health problem worldwide. Although there have been significative advances against cancer in the last two decades, incidence and death rates are increasing for several cancer types, including liver and pancreas. Continued clinical and basic researches are needed to further improve clinical quality care and diminish mortality caused by malignancies. In this context meta-analysis of diagnostic test accuracy studies represents a reliable methodological tool that facilitates structured high-quality evidence for efficient evidence summary and optimized decision-making regarding oncologic diagnosis and prognosis. However, the relative unfamiliarity of diagnostic test accuracy methods and its interpretation represent a challenge to the clinician that must be overcome. Additionally, previous studies have highlighted a limited quality of the literature regarding assessment of reporting systematic reviews of oncologic diagnostic test accuracy studies. Improvement on the execution and reporting of systematic reviews of diagnostic studies is needed. In this chapter we will summarize specific strategies to simplify the methodological complex system for reporting and interpreting case studies in oncology that will clearly have a positive impact on the quality of systematic reviews and meta-analysis of oncologic diagnostic test accuracy studies.

Keywords

Cancer Diagnostic test accuracy study Meta-analysis Evidence summary 

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Pew Research Center. Modern immigration wave brings 59 million to U.S., driving population growth and change through 2065: views of immigration’s impact on U.S. society mixed. Washington, DC: Pew Research Center; 2015.Google Scholar
  3. 3.
    Ferdinand R, Mitchell SA, Batson S, Tumur I. Treatments for chronic myeloid leukemia: a qualitative systematic review. J Blood Med. 2012;3:51–76.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM, Group CDTAW. Systematic reviews of diagnostic test accuracy. Ann Intern Med. 2008;149:889–97.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mulrow CD. Rationale for systematic reviews. BMJ. 1994;309:597–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bossuyt PM, Irwig L, Craig J, Glasziou P. Comparative accuracy: assessing new tests against existing diagnostic pathways. BMJ. 2006;332:1089–92.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Lord SJ, Irwig L, Simes RJ. When is measuring sensitivity and specificity sufficient to evaluate a diagnostic test, and when do we need randomized trials? Ann Intern Med. 2006;144:850–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Thornbury JR. Eugene W. Caldwell Lecture. Clinical efficacy of diagnostic imaging: love it or leave it. AJR Am J Roentgenol. 1994;162:1–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Glas AS, Roos D, Deutekom M, Zwinderman AH, Bossuyt PM, Kurth KH. Tumor markers in the diagnosis of primary bladder cancer. A systematic review. J Urol. 2003;169:1975–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Lokeshwar VB, Selzer MG. Urinary bladder tumor markers. Urol Oncol. 2006;24:528–37.CrossRefPubMedGoogle Scholar
  12. 12.
    Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157–62.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tatsioni A, Zarin DA, Aronson N, Samson DJ, Flamm CR, Schmid C, et al. Challenges in systematic reviews of diagnostic technologies. Ann Intern Med. 2005;142:1048–55.CrossRefPubMedGoogle Scholar
  14. 14.
    Begg CB. Biases in the assessment of diagnostic tests. Stat Med. 1987;6:411–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Dinnes J, Deeks J, Kirby J, Roderick P. A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy. Health Technol Assess. 2005;9:1–113.CrossRefPubMedGoogle Scholar
  16. 16.
    Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J. Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med. 2004;140:189–202.CrossRefPubMedGoogle Scholar
  17. 17.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Group Q-S. A systematic review classifies sources of bias and variation in diagnostic test accuracy studies. J Clin Epidemiol. 2013;66:1093–104.CrossRefPubMedGoogle Scholar
  18. 18.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36.CrossRefGoogle Scholar
  19. 19.
    Mallett S, Deeks JJ, Halligan S, Hopewell S, Cornelius V, Altman DG. Systematic reviews of diagnostic tests in cancer: review of methods and reporting. BMJ. 2006;333:413.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Oxman AD, Guyatt GH. The science of reviewing research. Ann N Y Acad Sci. 1993;703:125–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Navaneethan U, Hasan MK, Lourdusamy V, Njei B, Varadarajulu S, Hawes RH. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc. 2015;82:608–14.e2.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA. 1999;282:1061–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6:e012799.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol. 2005;5:19.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sulbaran M, de Moura E, Bernardo W, Morais C, Oliveira J, Bustamante-Lopez L, et al. Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis. Endosc Int Open. 2016;4:E151–63.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Arakawa D, Ohmiya N, Nakamura M, et al. Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc. 2009;69:866–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Buscaglia JM, Richards R, Wilkinson MN, et al. Diagnostic yield of spiral enteroscopy when performed for the evaluation of abnormal capsule endoscopy findings. J Clin Gastroenterol. 2011;45:342–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Fry LC, Neumann H, Kuester D, et al. Small bowel polyps and tumours: endoscopic detection and treatment by double-balloon enteroscopy. Aliment Pharmacol Ther. 2009;29:135–42.CrossRefPubMedGoogle Scholar
  30. 30.
    Fujimori S, Seo T, Gudis K, et al. Diagnosis and treatment of obscure gastrointestinal bleeding using combined capsule endoscopy and double balloon endoscopy: 1-year follow-up study. Endoscopy. 2007;39:1053–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Kamalaporn P, Cho S, Basset N, et al. Double-balloon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of a combined approach. Can J Gastroenterol. 2008;22:491–5.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kameda N, Higuchi K, Shiba M, et al. A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. J Gastroenterol. 2008;43:434–40.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee BI, Choi H, Choi KY, et al. Clinical characteristics of small bowel tumors diagnosed by double-balloon endoscopy: KASID multi-center study. Dig Dis Sci. 2011;56:2920–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Manno M, Riccioni ME, Cannizzaro R, et al. Diagnostic and therapeutic yield of single balloon enteroscopy in patients with suspected small-bowel disease: results of the Italian multicentre study. Dig Liver Dis. 2013;45:211–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Marmo R, Rotondano G, Casetti T, et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy. 2009;41:587–92.CrossRefPubMedGoogle Scholar
  36. 36.
    Matsumoto T, Esaki M, Moriyama T, et al. Comparison of capsule endoscopy and enteroscopy with the doubleballoon method in patients with obscure bleeding and polyposis. Endoscopy. 2005;37:827–32.CrossRefPubMedGoogle Scholar
  37. 37.
    Nakamura M, Niwa Y, Ohmiya N, et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding. Endoscopy. 2006;38:59–66.CrossRefPubMedGoogle Scholar
  38. 38.
    Partridge BJ, Tokar JL, Haluszka O, et al. Small bowel cancers diagnosed by device-assisted enteroscopy at a U.S. referral center: a five-year experience. Dig Dis Sci. 2011;56:2701–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Sethi S, Cohen J, Thaker AM, et al. Prior capsule endoscopy improves the diagnostic and therapeutic yield of single-balloon enteroscopy. Dig Dis Sci. 2014;59:2497–502.CrossRefPubMedGoogle Scholar
  40. 40.
    Vere CC, Foarfă C, Streba CT, et al. Videocapsule endoscopy and single balloon enteroscopy: novel diagnostic techniques in small bowel pathology. Rom J Morphol Embryol. 2009;50:467–74.PubMedGoogle Scholar
  41. 41.
    Li XB, Ge ZZ, Dai J, et al. The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases. Chin Med J (Engl). 2007;120:30–5.Google Scholar
  42. 42.
    Westwood ME, Whiting PF, Kleijnen J. How does study quality affect the results of a diagnostic meta-analysis? BMC Med Res Methodol. 2005;5:20.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Leeflang M, Reitsma J, Scholten R, Rutjes A, Di Nisio M, Deeks J, et al. Impact of adjustment for quality on results of metaanalyses of diagnostic accuracy. Clin Chem. 2007;53:164–72.CrossRefPubMedGoogle Scholar
  44. 44.
    Jones CM, Athanasiou T. Diagnostic accuracy meta-analysis: review of an important tool in radiological research and decision making. Br J Radiol. 2009;82:441–6.CrossRefPubMedGoogle Scholar
  45. 45.
    A proposal for more informative abstracts of clinical articles. Ad Hoc Working Group for Critical Appraisal of the Medical Literature. Ann Intern Med. 1987;106:598–604.Google Scholar
  46. 46.
    Ochodo EA, de Haan MC, Reitsma JB, Hooft L, Bossuyt PM, Leeflang MM. Overinterpretation and misreporting of diagnostic accuracy studies: evidence of “spin”. Radiology. 2013;267:581–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Sorensen HT, Sabroe S, Olsen J. A framework for evaluation of secondary data sources for epidemiological research. Int J Epidemiol. 1996;25:435–42.CrossRefPubMedGoogle Scholar
  48. 48.
    Leeflang MM, Bossuyt PM, Irwig L. Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis. J Clin Epidemiol. 2009;62:5–12.CrossRefPubMedGoogle Scholar
  49. 49.
    Doubilet P, Herman PG. Interpretation of radiographs: effect of clinical history. AJR Am J Roentgenol. 1981;137:1055–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Philbrick JT, Horwitz RI, Feinstein AR. Methodologic problems of exercise testing for coronary artery disease: groups, analysis and bias. Am J Cardiol. 1980;46:807–12.CrossRefPubMedGoogle Scholar
  51. 51.
    Knottnerus JA, Buntinx F. The evidence base of clinical diagnosis: theory and methods of diagnostic research. 2nd ed. London: BMJ Books; 2008.CrossRefGoogle Scholar
  52. 52.
    Ransohoff DF, Feinstein AR. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med. 1978;299:926–30.CrossRefPubMedGoogle Scholar
  53. 53.
    Knottnerus JA, Muris JW. Assessment of the accuracy of diagnostic tests: the cross-sectional study. J Clin Epidemiol. 2003;56:1118–28.CrossRefPubMedGoogle Scholar
  54. 54.
    Lang TA, Secic M. Generalizing from a sample to a population: reporting estimates and confidence intervals. Philadelphia: American College of Physicians; 1997.Google Scholar
  55. 55.
    Ioannidis JP, Evans SJ, Gøtzsche PC, O’Neill RT, Altman DG, Schulz K, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141:781–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Ioannidis JP, Lau J. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. JAMA. 2001;285:437–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sulbaran Marianny
    • 1
  • Sousa Afonso
    • 2
  • Bustamante-Lopez Leonardo
    • 2
  1. 1.Gastrointestinal Endoscopy Service, Gastroenterology DepartmentClinics Hospital, University of Sao Paulo School of MedicineSao PauloBrazil
  2. 2.Surgical Division, Gastroenterology DepartmentClinics Hospital, University of Sao Paulo School of MedicineSao PauloBrazil

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