Background: Subgroup analyses and meta-regression are commonly used to investigate heterogeneity in diagnostic test accuracy (DTA) meta-analyses (MA), but adherence to methodological guidance is unclear. This methodological review summarizes investigations of heterogeneity (IoH) in DTA-MAs, examining their frequency, characteristics, and alignment with recommendations. Methods: We included DTA-MAs published in 2024 reporting at least one pair of summary sensitivity and specificity. Non-DTA reviews, narrative syntheses, studies reporting only alternative measures, and overviews of systematic reviews were excluded. MEDLINE (via Ovid) was searched for English-language publications, with the final search in January 2025. Results: From 403 records, the most recent 100 DTA-MAs were included, each contributing one index test. IoH were reported in 61 analyses. The number of primary studies was positively associated with conducting an investigation (OR 1.66; p = 0.008). Subgroup analyses were used in 35/61 (57%), while 26/61 (43%) applied meta-regression alone or with subgroup analyses. Subgroup analyses examined fewer variables than meta-regression (p < 0.001). Among 44/61 (72%) analyses with sufficient detail to identify a statistical model, the bivariate model was used in 28/44 (64%), univariate random-effects models in 14/44 (32%), and the HSROC model in 5/44 (11%). Formal tests for subgroup differences were reported in 37/61 (61%). Protocols were available for 43/61 (70%) analyses, of which 19/43 (44%) fully prespecified IoH. Discussion: IoH were common and more likely when more primary studies were available, although individual subgroups were often supported by limited data. Reporting of statistical models and model choice was frequently unclear. Greater prespecification of IoH in protocols may reduce spurious findings and improve transparency in diagnostic research.

翻译：背景：亚组分析和荟萃回归常用于诊断准确性（DTA）荟萃分析（MA）中的异质性研究，但其对方法学指南的遵循情况尚不明确。本方法学综述总结了DTA-MA中异质性研究（IoH）的实施情况，考察其频率、特征及与推荐方法的契合度。方法：我们纳入了2024年发表、至少报告一对汇总敏感性与特异度的DTA-MA。非DTA综述、叙述性综述、仅报告替代指标的研究以及系统评价概览被排除。通过Ovid平台检索MEDLINE英文文献，最终检索时间为2025年1月。结果：从403条记录中纳入最新的100项DTA-MA，每项贡献一个指标检测。61项分析报告了IoH。原始研究数量与开展异质性研究呈正相关（OR 1.66；p = 0.008）。35/61项（57%）采用亚组分析，26/61项（43%）单独或联合使用荟萃回归。亚组分析考察的变量数量少于荟萃回归（p < 0.001）。在44/61项（72%）能识别统计模型的分析中，28/44项（64%）使用双变量模型，14/44项（32%）使用单变量随机效应模型，5/44项（11%）使用HSROC模型。37/61项（61%）报告了亚组差异的正式检验。43/61项（70%）可获得研究方案，其中19/43项（44%）完整预设了IoH。讨论：IoH较为普遍，且在原始研究较多时更可能实施，但单个亚组常受限于数据量。统计模型的报告与选择常不清晰。在研究方案中加强IoH的预设可减少偶然发现，提升诊断研究的透明度。