Since there are two sources of heterogeneity in the data, the within- and between-study variability, the parameters involved in a meta-analysis of diagnostic accuracy studies vary at two levels. For each study $i$, $i = 1, ..., n$, let $Y_{i}~=~(Y_{i1},~ Y_{i2})$ denote the true positives and true negatives, $N_{i}~=~( N_{i1},~ N_{i2})$ the diseased and healthy individuals respectively, and $\pi_{i}~ =~ (\pi_{i1},~ \pi_{i2})$ represent the `unobserved' sensitivity and specificity respectively.
Given study-specific sensitivity and specificity, two separate binomial distributions describe the distribution of true positives and true negatives among the diseased and the healthy individuals as follows
$$Y_{ij}~ |~ \pi_{ij}, ~\textbf{x}_i~ \sim~ bin(\pi_{ij},~ N_{ij}), i~=~1, ~\dots ~n, ~j~=~1, ~2$$