Abstract
As direct detection methods of Borrelia burgdorferi are limited, serology plays an important role in diagnosing Lyme disease (LD). There are various types of Lyme serological tests with varying diagnostic accuracy, so it is necessary to compare and rank them. The aim of this study is to compare the accuracy of various serological diagnostic methods for LD using network meta-analysis (NMA). We searched the Cochrane Library and PubMed databases for all serological diagnostic accuracy studies published from the discovery of LD until June 2024. After screening, we assessed the quality of the included studies with QUADAS-C and extracted relevant data. We calculated the Q* index of the receiver operating characteristic curve for each diagnostic test. Meta-disc 2.0 and Stata 15.0 were used to perform traditional meta-analysis and NMA with the gold standard (the comprehensive evaluation) as a reference. We then compared the Q* index values between different methods using two-by-two comparisons and ranked them accordingly. A total of 52 studies with 181,032 participants, including 5318 patients with LD, were included. These studies covered 14 diagnostic methods. The results of the NMA suggest that modified two-tiered testing (MTTT), C6 enzyme immunoassay (EIA), and standard two-tiered testing (STTT) rank in the top three among the 14 methods in terms of Q* index, with MTTT being the highest, followed by C6 EIA and STTT. MTTT and C6 EIA have higher overall diagnostic performance, and their accuracy is not inferior to that of the widely used STTT (PROSPERO CRD42022378326).