The review addressed a focused question, supported by clearly defined inclusion criteria. The literature search was poorly described, with only a selection of the databases searched described. There were no additional attempts to locate relevant studies or to identify unpublished studies. Therefore, it is likely that relevant studies have been missed and the review may be subject to publication bias. Details on the review process were not reported, so it was not possible to determine whether appropriate steps were taken to minimise bias and errors.
Study quality was not formally assessed, although restriction of the review to prospective diagnostic cohort studies in a defined group of patients meant that all the included studies fulfilled some relevant quality criteria for diagnostic accuracy studies. Blinding was also assessed and found to be lacking. Other possible sources of bias, in particular verification bias, were not discussed, so it is unclear whether these may have been present in the included studies. A formal statistical analysis including assessment and investigation of heterogeneity would have been more informative than the very limited narrative summary of results presented.
Given the limitations of this review, in particular the possibility of missing studies and limited synthesis, the authors' conclusions are unlikely to be reliable.