How to assess the methodological quality of systematic reviews of diagnostic trials.

It is discussed how the methodological quality of systematic reviews of diagnostic tests can be assessed. Different types of diagnostic questions require different types of systematic reviews. Reviews of diagnostic accuracy are important in choosing the best test for diagnostic confirmation, but information on the diagnostic-therapeutic impact is even more relevant. A thorough assessment of whether a new test is worth doing in the clinical setting requires that primary studies and systematic reviews address the impact on changes in management.