Estimation of Performance and Sequential Selection of Diagnostic Tests in Patients With Lung Lesions Suspicious for Cancer

2002 ◽  
Vol 126 (1) ◽  
pp. 19-27
Author(s):  
Dana Marie Grzybicki ◽  
Thomas Gross ◽  
Kim R. Geisinger ◽  
Stephen S. Raab
Keyword(s):  
Diagnostic Test ◽  
Test Performance ◽  
Diagnostic Tests ◽  
Needle Aspiration ◽  
Selection Strategy ◽  
Test Selection ◽  
Lung Lesions ◽  
Sequential Selection ◽  
Test Ordering ◽  
Selection Of

Abstract Context.—Measuring variation in clinician test ordering behavior for patients with similar indications is an important focus for quality management and cost containment. Objective.—To obtain information from physicians and nonphysicians regarding their test-ordering behavior and their knowledge of test performance characteristics for diagnostic tests used to work up patients with lung lesions suspicious for cancer. Design.—A self-administered, voluntary, anonymous questionnaire was distributed to 452 multiple-specialty physicians and 500 nonphysicians in academic and private practice in Pennsylvania, Iowa, and North Carolina. Respondents indicated their estimates of test sensitivities for multiple tests used in the diagnosis of lung lesions and provided their test selection strategy for case simulations of patients with solitary lung lesions. Data were analyzed using descriptive statistics and the χ2 test. Results.—The response rate was 11.2%. Both physicians and nonphysicians tended to underestimate the sensitivities of all minimally invasive tests, with the greatest underestimations reported for sputum cytology and transthoracic fine-needle aspiration biopsy. There was marked variation in sequential test selection for all the case simulations and no association between respondent perception of test sensitivity and their selection of first diagnostic test. Overall, the most frequently chosen first diagnostic test was bronchoscopy. Conclusions.—Physicians and nonphysicians tend to underestimate the performance of diagnostic tests used to evaluate solitary lung lesions. However, their misperceptions do not appear to explain the wide variation in test-ordering behavior for patients with lung lesions suspicious for cancer.

scholarly journals The Use of Latent Class Analysis to Estimate the Sensitivities and Specificities of Diagnostic Tests for Squash vein yellowing virus in Cucurbit Species When There Is No Gold Standard

2013 ◽  
Vol 103 (12) ◽  
pp. 1243-1251 ◽  
Author(s):  
William W. Turechek ◽  
Craig G. Webster ◽  
Jingyi Duan ◽  
Pamela D. Roberts ◽  
Chandrasekar S. Kousik ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Diagnostic Test ◽  
Test Performance ◽  
Gold Standard ◽  
Diagnostic Tests ◽  
Latent Class ◽  
Visual Assessment ◽  
Class Analysis ◽  
Rt Pcr ◽  
Yellowing Virus

Squash vein yellowing virus (SqVYV) is the causal agent of viral watermelon vine decline, one of the most serious diseases in watermelon (Citrullus lanatus L.) production in the southeastern United States. At present, there is not a gold standard diagnostic test for determining the true status of SqVYV infection in plants. Current diagnostic methods for identification of SqVYV-infected plants or tissues are based on the reverse-transcription polymerase chain reaction (RT-PCR), tissue blot nucleic acid hybridization assays (TB), and expression of visual symptoms. A quantitative assessment of the performance of these diagnostic tests is lacking, which may lead to an incorrect interpretation of results. In this study, latent class analysis (LCA) was used to estimate the sensitivities and specificities of RT-PCR, TB, and visual assessment of symptoms as diagnostic tests for SqVYV. The LCA model assumes that the observed diagnostic test responses are linked to an underlying latent (nonobserved) disease status of the population, and can be used to estimate sensitivity and specificity of the individual tests, as well as to derive an estimate of the incidence of disease when a gold standard test does not exist. LCA can also be expanded to evaluate the effect of factors and was done here to determine whether diagnostic test performances varied among the type of plant tissue being tested (crown versus vine tissue), where plant samples were taken relative to the position of the crown (i.e., distance from the crown), host (i.e., genus), and habitat (field-grown versus greenhouse-grown plants). Results showed that RT-PCR had the highest sensitivity (0.94) and specificity (0.98) of the three tests. TB had better sensitivity than symptoms for detection of SqVYV infection (0.70 versus 0.32), while the visual assessment of symptoms was more specific than TB and, thus, a better indicator of noninfection (0.98 versus 0.65). With respect to the grouping variables, RT-PCR and TB had better sensitivity but poorer specificity for diagnosing SqVYV infection in crown tissue than it did in vine tissue, whereas symptoms had very poor sensitivity but excellent specificity in both tissues for all cucurbits analyzed in this study. Test performance also varied with habitat and genus but not with distance from the crown. The results given here provide quantitative measurements of test performance for a range of conditions and provide the information needed to interpret test results when tests are used in parallel or serial combination for a diagnosis.

Design of a Decision Support System for Test Ordering in General Practice: Choices and Decisions to Make

1999 ◽  
Vol 38 (04/05) ◽  
pp. 355-361 ◽  
Author(s):  
M. Mosseveld ◽  
J. van der Lei ◽  
M. van Wijk
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
General Practitioners ◽  
Support System ◽  
Diagnostic Tests ◽  
Electronic Patient Records ◽  
Blood Tests ◽  
The Past ◽  
Test Ordering ◽  
Selection Of

AbstractThe increased availability of tests in the past years has been accompanied by an increased number of blood tests ordered by general practitioners. Dutch investigators report a lack of general practitioners’ knowledge concerning the indications for blood tests leading to inappropriate and inadequate use of diagnostic tests. Taking advantage of the use of electronic patient records by Dutch general practitioners, the authors replaced the traditional paper forms for test ordering by a decision-support system. The objective of the decision-support system is to change test-ordering behavior. Designing a system to change test-ordering behavior, however, required the selection of a method to provide support. To study different methods for changing test-ordering behavior, the authors developed two versions of the decision-support system BloodLink. The first version, Blood-Link-Restricted, is based on the notion of restricting the number of choices presented to the general practitioners. The second version, BloodLink-Guideline, is based on the guidelines provided by the Dutch college of general practitioners.

The Use of Information Graphs to Evaluate and Compare Diagnostic Tests

2002 ◽  
Vol 41 (02) ◽  
pp. 114-118 ◽  
Author(s):  
W. A. Benish
Keyword(s):  
Diagnostic Test ◽  
Relative Entropy ◽  
Test Performance ◽  
Diagnostic Tests ◽  
Critical Role ◽  
Diagnostic Information ◽  
Pretest Probability ◽  
Operating Characteristics ◽  
Diagnostic Uncertainty ◽  
Diagnostic Test Performance

Summary Objectives: The purpose of this communication is to demonstrate the use of “information graphs” as a means of characterizing diagnostic test performance. Methods: Basic concepts in information theory allow us to quantify diagnostic uncertainty and diagnostic information. Given the probabilities of the diagnoses that can explain a patient’s condition, the entropy of that distribution is a measure of our uncertainty about the diagnosis. The relative entropy of the posttest probabilities with respect to the pretest probabilities quantifies the amount of information gained by diagnostic testing. Mutual information is the expected value of relative entropy and, hence, provides a measure of expected diagnostic information. These concepts are used to derive formulas for calculating diagnostic information as a function of pretest probability for a given pair of test operating characteristics. Results: Plots of diagnostic information as a function of pretest probability are constructed to evaluate and compare the performance of three tests commonly used in the diagnosis of coronary artery disease. The graphs illustrate the critical role that the pretest probability plays in determining diagnostic test information. Conclusions: Information graphs summarize diagnostic test performance and offer a way to evaluate and compare diagnostic tests.

scholarly journals Prevalence-Value-Accuracy Plots: A New Method for Comparing Diagnostic Tests Based on Misclassification Costs

1999 ◽  
Vol 45 (7) ◽  
pp. 934-941 ◽  
Author(s):  
Alan T Remaley ◽  
Maureen L Sampson ◽  
James M DeLeo ◽  
Nancy A Remaley ◽  
Beriuse D Farsi ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Test Performance ◽  
Diagnostic Tests ◽  
Decision Threshold ◽  
Area Index ◽  
Misclassification Costs ◽  
Plot Analysis ◽  
Optimum Decision ◽  
Diagnostic Test Performance ◽  
The Cost

Abstract The clinical accuracy of diagnostic tests commonly is assessed by ROC analysis. ROC plots, however, do not directly incorporate the effect of prevalence or the value of the possible test outcomes on test performance, which are two important factors in the practical utility of a diagnostic test. We describe a new graphical method, referred to as a prevalence-value-accuracy (PVA) plot analysis, which includes, in addition to accuracy, the effect of prevalence and the cost of misclassifications (false positives and false negatives) in the comparison of diagnostic test performance. PVA plots are contour plots that display the minimum cost attributable to misclassifications (z-axis) at various optimum decision thresholds over a range of possible values for prevalence (x-axis) and the unit cost ratio (UCR; y-axis), which is an index of the cost of a false-positive vs a false-negative test result. Another index based on the cost of misclassifications can be derived from PVA plots for the quantitative comparison of test performance. Depending on the region of the PVA plot that is used to calculate the misclassification cost index, it can potentially lead to a different interpretation than the ROC area index on the relative value of different tests. A PVA-threshold plot, which is a variation of a PVA plot, is also described for readily identifying the optimum decision threshold at any given prevalence and UCR. In summary, the advantages of PVA plot analysis are the following: (a) it directly incorporates the effect of prevalence and misclassification costs in the analysis of test performance; (b) it yields a quantitative index based on the costs of misclassifications for comparing diagnostic tests; (c) it provides a way to restrict the comparison of diagnostic test performance to a clinically relevant range of prevalence and UCR; and (d) it can be used to directly identify an optimum decision threshold based on prevalence and misclassification costs.

scholarly journals Evaluation of binary diagnostic tests accuracy for medical researches

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jale Karakaya
Keyword(s):  
Diagnostic Test ◽  
Performance Measures ◽  
Test Performance ◽  
Diagnostic Tests ◽  
Sample Size Calculation ◽  
Rapid Test ◽  
Screening Tests ◽  
Youden Index ◽  
Predictive Values ◽  
Test Result

AbstractObjectivesThe aim of this study is to introduce the features of diagnostic tests. In addition, it will be demonstrated which performance measures can be used for diagnostic tests with binary results, the properties of these measures and how to interpret them.Materials and MethodsThe evaluation of the diagnostic test performance measures may differ depending on whether the test result is numerical or binary. When the diagnostic test result is continuous numerical data, ROC analysis is often utilized. The performance of a diagnostic test with binary results are usually evaluated using the measures of sensitivity and specificity. However, there are some important measures other than these two measures for binary test results. These measures are predictive values, overall accuracy, diagnostic odds ratio, Youden index, and likelihood ratios.ResultsA hypothetical data has been produced based on the studies conducted on the performance of rapid tests (Specific IgM/IgG) according to the RT-PCR test for Covid 19 in the literature. An example of a diagnostic test (Specific IgM/IgG) with a binary result is given and all measurements and their confidence interval are obtained for this data. The performance of rapid test was examined and interpreted.ConclusionIt is important to design and evaluate the performance of diagnostic/screening tests for health care. In this review, some basic definitions, performance measures that can be used only in evaluating the diagnostic tests with binary results and their confidence intervals are mentioned. Having many different measures provides different interpretations in the evaluation of test performance. Accurately predicting the performance of a diagnostic test depends on many factors. These factors can be study design, criteria of participant selection, sample size calculation, test methods etc. There are guidelines that ensure that all information regarding the conditions under which the study was conducted is in report, in terms of such factors. Therefore, these guidelines are recommended for use of the checklist by many publishers.

A Comparison of Four Adolescent Language Tests

1987 ◽  
Vol 18 (3) ◽  
pp. 250-266 ◽  
Author(s):  
R. Jane Lieberman ◽  
Ann Marie C. Heffron ◽  
Stephanie J. West ◽  
Edward C. Hutchinson ◽  
Thomas W. Swem
Keyword(s):  
Test Performance ◽  
Sixth Grade ◽  
Significant Discrepancy ◽  
Language Impaired ◽  
Language Functions ◽  
Language Tests ◽  
Significant Difference ◽  
Sixth Grade Students ◽  
Overall Performance ◽  
Selection Of

Four recently developed adolescent language tests, the Fullerton Test for Adolescents (FLTA), the Test of Adolescent Language (TOAL), the Clinical Evaluation of Language Functions (CELF), and the Screening Test of Adolescent Language (STAL), were compared to determine: (a) whether they measured the same language skills (content) in the same way (procedures); and (b) whether students performed similarly on each of the tests. First, respective manuals were reviewed to compare selection of subtest content areas and subtest procedures. Then, each of the tests was administered according to standardized procedures to 30 unselected sixth-grade students. Despite apparent differences in test content and procedures, there was no significant difference in students' performance on three of the four tests, and correlations among test performance were moderate to high. A comparison of the pass/fail rates for overall performance on the tests, however, revealed a significant discrepancy between the proportions of students identified in need of further evaluation on the STAL (20%) and the proportion diagnosed as language impaired on the three diagnostic tests (60-73%). Clinical implications are discussed.

scholarly journals Diagnosis of tuberculosis in wildlife: a systematic review

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Jobin Thomas ◽  
Ana Balseiro ◽  
Christian Gortázar ◽  
María A. Risalde
Keyword(s):  
Systematic Review ◽  
Test Performance ◽  
Diagnostic Tests ◽  
Large Scale ◽  
Diagnostic Techniques ◽  
Review Literature ◽  
Meat Industry ◽  
Post Mortem ◽  
Serological Tests ◽  
Ongoing Research

AbstractAnimal tuberculosis (TB) is a multi-host disease caused by members of the Mycobacterium tuberculosis complex (MTC). Due to its impact on economy, sanitary standards of milk and meat industry, public health and conservation, TB control is an actively ongoing research subject. Several wildlife species are involved in the maintenance and transmission of TB, so that new approaches to wildlife TB diagnosis have gained relevance in recent years. Diagnosis is a paramount step for screening, epidemiological investigation, as well as for ensuring the success of control strategies such as vaccination trials. This is the first review that systematically addresses data available for the diagnosis of TB in wildlife following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The article also gives an overview of the factors related to host, environment, sampling, and diagnostic techniques which can affect test performance. After three screenings, 124 articles were considered for systematic review. Literature indicates that post-mortem examination and culture are useful methods for disease surveillance, but immunological diagnostic tests based on cellular and humoral immune response detection are gaining importance in wildlife TB diagnosis. Among them, serological tests are especially useful in wildlife because they are relatively inexpensive and easy to perform, facilitate large-scale surveillance and can be used both ante- and post-mortem. Currently available studies assessed test performance mostly in cervids, European badgers, wild suids and wild bovids. Research to improve diagnostic tests for wildlife TB diagnosis is still needed in order to reach accurate, rapid and cost-effective diagnostic techniques adequate to a broad range of target species and consistent over space and time to allow proper disease monitoring.

scholarly journals Efficacy of rapid on-site cytological evaluation (ROSE) by a pulmonologist in determining specimen adequacy and diagnostic accuracy in interventional diagnosis of lung lesions

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098268
Author(s):  
Mingli Yuan ◽  
Yafei Wang ◽  
Wen Yin ◽  
Yang Xiao ◽  
Manman Hu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Diagnostic Accuracy ◽  
Cell Carcinoma ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Small Cell ◽  
Diagnostic Efficacy ◽  
Lung Lesions ◽  
Fine Needle ◽  
Cytological Evaluation

Objective To evaluate the efficacy of rapid on-site cytological evaluation (ROSE) in determining specimen adequacy and diagnostic accuracy in the interventional diagnosis of lung lesions. Methods This retrospective study included 127 consecutive cases of lung lesions, which were sampled by bronchoscopy or transthoracic fine needle aspiration, and diagnosed on ROSE followed by histopathology. ROSE was performed by a trained pulmonologist and the diagnosis of ROSE was compared with the final diagnosis. Results The sensitivity of ROSE in determining adequacy of specimens was 97.5% and specificity in determining inadequacy was 85.7%. The diagnostic efficacy of ROSE for assessing malignancy (sensitivity of 94.5% and specificity of 100%) and non-malignancy (sensitivity of 97.8% and specificity of 100%) was excellent. The sensitivity of ROSE for diagnosing small cell carcinoma (100%) was highest, followed by adenocarcinoma (89.2%) and squamous cell carcinoma (75.0%). Performance of ROSE by a trained pulmonologist also determined tuberculosis with a high diagnostic sensitivity (83.3%) and specificity (100%). Conclusions A trained pulmonologist can reliably carry out ROSE to ensure the adequacy of the sample, distinguish between malignancy and non-malignancy, and make a preliminary diagnosis in a large number of cases.

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