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

Authors：

ZHENG Qingyong ^1,2,3 , ZHOU Yongjia ^1,2,3,4 , XU Jianguo ^1,2,3 , GAO Ya ^1,2,3 , LIU Ming ^1,2,3 , GE Long ^3,5,6 , LI Lun ^7,8 , WANG Quan ⁹ , HUANG Yan ¹⁰ , LI Jiang ¹¹ ,  ZHANG Junhua ¹² ,  TIAN Jinhui ^1,2,3

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. Research Unit of Evidence-bacsed Evaluation and Guidelines, Chinese Academy of Medical Sciences, Lanzhou 730000, P. R. China;
4. School of Nursing, Gansu University of Chinese Medicine, Lanzhou 730000, P. R. China;
5. Evidence-Based Social Sciences Research Centre, Lanzhou University, Lanzhou 730000, P. R. China;
6. Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
7. Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, P. R. China;
8. Clinical Research Center of Hunan Province, Changsha 410011, P. R. China;
9. Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi’an 710068, P. R. China;
10. China Medical University, Shenyang 110122, P. R. China;
11. 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;
12. 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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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.

Citation： ZHENG Qingyong, ZHOU Yongjia, XU Jianguo, GAO Ya, LIU Ming, GE Long, LI Lun, WANG Quan, HUANG Yan, LI Jiang, ZHANG Junhua, TIAN Jinhui. Advancements and challenges in network meta-analysis of diagnostic test accuracy. Chinese Journal of Evidence-Based Medicine, 2025, 25(3): 349-357. doi: 10.7507/1672-2531.202409119 Copy

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.	陸瑤, 楊秋玉, 劉雅菲, 等. 如何制作診斷試驗準確性比較的系統評價與Meta分析. 中國循證醫學雜志, 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.	楊秋玉, 陸瑤, 田晨, 等. 診斷試驗準確性比較研究: 研究設計. 中國循證醫學雜志, 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. Cham: Springer, 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.	高亞, 孫鳳, 武珊珊, 等. 網絡Meta分析研究進展系列(五): 診斷試驗準確性網絡Meta分析. 中國循證心血管醫學雜志, 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-W12.
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.	劉關鍵, 吳泰相. 診斷性試驗的Meta分析—SROC曲線法介紹. 中國循證醫學雜志, 2003, 3(1): 41-44.
19.	滕芬. 住院癌癥患者自殺風險因素與自殺意念的關系及預防干預策略. 武漢: 華中科技大學, 2020.
20.	張天嵩, 熊茜. 網絡Meta分析在R軟件中的實現. 循證醫學, 2012, 12(3): 185-188.
21.	曾憲濤, 曹世義, 孫鳳, 等. Meta分析系列之六: 間接比較及網狀分析. 中國循證心血管醫學雜志, 2012, 4(5): 399-402.
22.	曾憲濤, 徐暢, 張超, 等. 網狀Meta分析在Stata軟件中的實現. 中國循證醫學雜志, 2013, 13(11): 1387-1391.
23.	張家華, 葛龍, 田金徽, 等. PET/CT和CT診斷宮頸癌腹主動脈淋巴結轉移間接比較的Meta分析. 蘭州大學學報(醫學版), 2015, 41(1): 34-42.
24.	鄧惠尹. 膿毒癥相關腦功能障礙動物模型的建立及生物標志物分析. 長沙: 中南大學, 2023.
25.	吳景玲, 潘蓓, 葛龍, 等. ANOVA模型實現貝葉斯方法的診斷試驗準確性網狀Meta分析. 中國循證醫學雜志, 2017, 17(9): 1111-1116.
26.	徐雪瀅. 基于Beta分布的診斷性試驗三元網狀Meta分析模型的構建及應用研究. 沈陽: 中國醫科大學, 2021.
27.	田金徽, 葛龍, 趙曄, 等. 網狀Meta分析優先報告條目: PRISMA擴展聲明解讀. 中國藥物評價, 2015, (5): 266-272.
28.	張永剛, 楊樂天, 楊鑫, 等. 診斷準確性試驗的系統評價/Meta分析報告規范(PRISMA-DTA)的解讀. 中國循證醫學雜志, 2018, 18(9): 1007-1016.
29.	林麗玉, 許麗春, 張鑫, 等. 7種營養篩查工具對癌癥患者營養篩查準確性的網狀Meta分析. 護理學雜志, 2022, 37(12): 92-96.
30.	鄭曉娜, 陳秋華, 邵庭芳, 等. 9種吞咽障礙篩查量表準確性的網狀Meta分析. 中華護理雜志, 2019, 54(10): 1561-1566.
31.	吳景玲, 葛龍, 張俊華, 等. 多個診斷性試驗準確性的比較: 網狀Meta分析方法介紹. 中國循證醫學雜志, 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, 楊秋玉, 賴鴻皓, 等. 診斷性試驗準確性比較研究. 中國循證醫學雜志, 2022, 22(5): 590-594.
39.	李響. X線診斷痛風性關節炎患者的臨床診斷準確性探討. 影像研究與醫學應用, 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.	鄔蘭, 張永, 曾憲濤. QUADAS-2在診斷準確性研究的質量評價工具中的應用. 湖北醫藥學院學報, 2013, 32(3): 201-208.
47.	黃玉香, 沈建通, 劉雨今. 診斷試驗準確性比較研究偏倚風險評價工具QUADAS-C解讀. 中國循證醫學雜志, 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, 焦彥霞, 魏育婷, 等. ICU患者壓力性損傷風險評估工具準確性的網狀Meta分析. 護理學雜志, 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, 王韻華, 賴鴻皓, 等. 網狀Meta分析證據質量分級: CINeMA在線應用程序簡介. 中國循證醫學雜志, 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. 陸瑤, 楊秋玉, 劉雅菲, 等. 如何制作診斷試驗準確性比較的系統評價與Meta分析. 中國循證醫學雜志, 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. 楊秋玉, 陸瑤, 田晨, 等. 診斷試驗準確性比較研究: 研究設計. 中國循證醫學雜志, 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. Cham: Springer, 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. 高亞, 孫鳳, 武珊珊, 等. 網絡Meta分析研究進展系列(五): 診斷試驗準確性網絡Meta分析. 中國循證心血管醫學雜志, 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-W12.
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. 劉關鍵, 吳泰相. 診斷性試驗的Meta分析—SROC曲線法介紹. 中國循證醫學雜志, 2003, 3(1): 41-44.
19. 滕芬. 住院癌癥患者自殺風險因素與自殺意念的關系及預防干預策略. 武漢: 華中科技大學, 2020.
20. 張天嵩, 熊茜. 網絡Meta分析在R軟件中的實現. 循證醫學, 2012, 12(3): 185-188.
21. 曾憲濤, 曹世義, 孫鳳, 等. Meta分析系列之六: 間接比較及網狀分析. 中國循證心血管醫學雜志, 2012, 4(5): 399-402.
22. 曾憲濤, 徐暢, 張超, 等. 網狀Meta分析在Stata軟件中的實現. 中國循證醫學雜志, 2013, 13(11): 1387-1391.
23. 張家華, 葛龍, 田金徽, 等. PET/CT和CT診斷宮頸癌腹主動脈淋巴結轉移間接比較的Meta分析. 蘭州大學學報(醫學版), 2015, 41(1): 34-42.
24. 鄧惠尹. 膿毒癥相關腦功能障礙動物模型的建立及生物標志物分析. 長沙: 中南大學, 2023.
25. 吳景玲, 潘蓓, 葛龍, 等. ANOVA模型實現貝葉斯方法的診斷試驗準確性網狀Meta分析. 中國循證醫學雜志, 2017, 17(9): 1111-1116.
26. 徐雪瀅. 基于Beta分布的診斷性試驗三元網狀Meta分析模型的構建及應用研究. 沈陽: 中國醫科大學, 2021.
27. 田金徽, 葛龍, 趙曄, 等. 網狀Meta分析優先報告條目: PRISMA擴展聲明解讀. 中國藥物評價, 2015, (5): 266-272.
28. 張永剛, 楊樂天, 楊鑫, 等. 診斷準確性試驗的系統評價/Meta分析報告規范(PRISMA-DTA)的解讀. 中國循證醫學雜志, 2018, 18(9): 1007-1016.
29. 林麗玉, 許麗春, 張鑫, 等. 7種營養篩查工具對癌癥患者營養篩查準確性的網狀Meta分析. 護理學雜志, 2022, 37(12): 92-96.
30. 鄭曉娜, 陳秋華, 邵庭芳, 等. 9種吞咽障礙篩查量表準確性的網狀Meta分析. 中華護理雜志, 2019, 54(10): 1561-1566.
31. 吳景玲, 葛龍, 張俊華, 等. 多個診斷性試驗準確性的比較: 網狀Meta分析方法介紹. 中國循證醫學雜志, 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, 楊秋玉, 賴鴻皓, 等. 診斷性試驗準確性比較研究. 中國循證醫學雜志, 2022, 22(5): 590-594.
39. 李響. X線診斷痛風性關節炎患者的臨床診斷準確性探討. 影像研究與醫學應用, 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. 鄔蘭, 張永, 曾憲濤. QUADAS-2在診斷準確性研究的質量評價工具中的應用. 湖北醫藥學院學報, 2013, 32(3): 201-208.
47. 黃玉香, 沈建通, 劉雨今. 診斷試驗準確性比較研究偏倚風險評價工具QUADAS-C解讀. 中國循證醫學雜志, 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, 焦彥霞, 魏育婷, 等. ICU患者壓力性損傷風險評估工具準確性的網狀Meta分析. 護理學雜志, 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.
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