Liquid biopsy in meningioma: a meta-analysis of diagnostic accuracy across fluid-based biomarkers

This systematic review and meta-analysis of diagnostic test accuracy evaluated the performance of noninvasive liquid biopsy methods for diagnosis of meningioma, the most common primary intracranial neoplasm in adults. Following PRISMA-DTA guidelines, we searched three databases. Data for 2 × 2 contingency tables were extracted, methodological quality was assessed using QUADAS-2, and a bivariate meta-analysis was performed. A total of 23 studies with 27 datasets were included. Pooled sensitivity was 0.78 (95% CI: 0.71 – 0.83) and specificity was 0.82 (95% CI: 0.76 – 0.86), with an area under the curve (AUC) of 0.86. Subgroup analysis showed that seroreactivity assays had the highest accuracy (diagnostic odds ratio or DOR = 67), while emerging technologies like cfDNA methylation showed high potential but were supported by limited data. The evidence was limited by significant publication bias (Deeks’ test, <i>p</i> &lt; 0.001), and meta-regression revealed that studies with a lower risk of bias reported significantly lower specificity (<i>p</i> = 0.008). Fluid-based biomarkers show good overall accuracy for meningioma diagnosis, but the current evidence is compromised by methodological bias, suggesting that true performance is more modest than reported. Rigorous, prospective validation of promising approaches like cfDNA methylation and seroreactivity is essential to clarify their clinical utility.