title: Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews.
abstract: OBJECTIVE
  Studies of diagnostic accuracy most often report pairs of sensitivity and specificity. We demonstrate the advantage of using bivariate meta-regression models to analyze such data.
  
  
  METHODS
  We discuss the methodology of both the summary Receiver Operating Characteristic (sROC) and the bivariate approach by reanalyzing the data of a published meta-analysis.
  
  
  RESULTS
  The sROC approach is the standard method for meta-analyzing diagnostic studies reporting pairs of sensitivity and specificity. This method uses the diagnostic odds ratio as the main outcome measure, which removes the effect of a possible threshold but at the same time loses relevant clinical information about test performance. The bivariate approach preserves the two-dimensional nature of the original data. Pairs of sensitivity and specificity are jointly analyzed, incorporating any correlation that might exist between these two measures using a random effects approach. Explanatory variables can be added to the bivariate model and lead to separate effects on sensitivity and specificity, rather than a net effect on the odds ratio scale as in the sROC approach. The statistical properties of the bivariate model are sound and flexible.
  
  
  CONCLUSIONS
  The bivariate model can be seen as an improvement and extension of the traditional sROC approach.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. j.reitsma@amc.uva.nl
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Afina S
authors.initials: AS
authors.lastname: Glas
authors.forename: Anne W S
authors.initials: AW
authors.lastname: Rutjes
authors.forename: Rob J P M
authors.initials: RJ
authors.lastname: Scholten
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
mesh_terms: D003627:Data Interpretation, Statistical; D019937:Diagnostic Techniques and Procedures; D006801:Humans; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care / Q000379:methods; D012372:ROC Curve; D012196:Review Literature as Topic; D012680:Sensitivity and Specificity