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Diagnostic Testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
OBJECTIVES OF LECTURE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Section A Diagnosis and  Diagnostic Testing
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Way of diagnosis ,[object Object],[object Object],[object Object],[object Object]
Way of diagnosis ,[object Object],[object Object],[object Object],[object Object]
Way of diagnosis ,[object Object],[object Object],[object Object]
Diagnostic testing ,[object Object],[object Object]
Section B Assessment on Diagnostic Testing
Diagnostic Tests ,[object Object],[object Object]
Diagnostic Tests ,[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],The way to evaluate a new diagnostic test Continued
Selection of Gold standard ,[object Object],[object Object],[object Object],[object Object],[object Object]
Selection of subjects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Selection of subjects ,[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Creating a 2 x 2 Table New Test True P False P False N True N
Dichotomous model ,[object Object],[object Object],[object Object],[object Object]
Dichotomous model ,[object Object],[object Object],[object Object],[object Object]
DIAGNOSTIC ACCURACY OF A TEST Definition The extent to which the results of a diagnostic test reflect true disease status Terminology Accuracy / Validity interchangeable
Indicators for assessing diagnostic test
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Sensitivity
Developmental characteristics: test parameters ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Specificity
Developmental characteristics: test parameters ,[object Object],[object Object]
Developmental characteristics: test parameters ,[object Object],[object Object]
Developmental characteristics: test parameters ,[object Object],[object Object]
Developmental characteristics: test parameters ,[object Object],[object Object]
Example ,[object Object],[object Object],[object Object],[object Object]
Resulting 2 x 2 Table ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sensitivity and Specificity ,[object Object],[object Object],Continued
Sensitivity and Specificity ,[object Object],[object Object]
Positive and Negative Predictive Value ,[object Object],[object Object],[object Object]
Positive Predictive Value ,[object Object],[object Object]
Resulting 2 x 2 Table ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Positive Predictive Value ,[object Object],[object Object],Continued
Positive Predictive Value ,[object Object],[object Object],Continued
Positive Predictive Value ,[object Object],[object Object],[object Object]
Negative Predictive Value ,[object Object],[object Object],Continued
Negative Predictive Value ,[object Object],[object Object]
Negative Predictive Value ,[object Object],[object Object],Continued
Negative Predictive Value ,[object Object],[object Object],[object Object]
Notes on Interpretation ,[object Object],[object Object],Continued
Notes on Interpretation ,[object Object],[object Object],[object Object],Continued
Notes on Interpretation ,[object Object],[object Object]
Summary ,[object Object],[object Object],Continued
Summary ,[object Object],[object Object],Continued
Summary ,[object Object]
Likelihood Ratios and Post-Test Disease Probability
Likelihood Ratio(LR) ,[object Object]
Clinical Interpretation: likelihood ratios ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Pretest odds of disease ,[object Object],[object Object],[object Object]
Posttest odds of disease ,[object Object],[object Object],[object Object]
Posttest probability ,[object Object],[object Object]
Clinical interpretation of post-test probability Disease ruled out Disease ruled in
Advantages of LRs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Advantages of LRs ,[object Object]
Likelihood Ratios - Advantage ,[object Object],[object Object],[object Object],[object Object],[object Object]
Figure 1a :  Likelihood Ratio  Nomogram
Figure 1b :  Likelihood Ratio  Nomogram
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) Healthy
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) Healthy   Sick
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) Fals pos= 20%   True pos=82%
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) F pos= 100%  T pos=100%
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) Fals pos= 9%   True pos=70%
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) T neg= 100%  F neg=100%
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) “ F pos +  T pos “ is the highest
 
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) Receiver Operating Characteristic (ROC)
Developmental characteristics: Cut-points and Receiver Operating Characteristic (ROC) Receiver Operating Characteristic (ROC)
Receiver Operating Characteristic (ROC) ,[object Object],[object Object]
 
Section C ,[object Object]
Combination tests: serial and parallel testing ,[object Object],[object Object],[object Object]
Combination tests: serial testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Combination tests: serial testing   Demonstration: Serial Testing with Independent Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Combination tests: parallel testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Combination tests: parallel testing   Demonstration: Parallel Testing with Independent Tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical settings for parallel testing ,[object Object],[object Object]
[object Object]
Clinical settings for serial testing ,[object Object]
Calculate sensitivity and specificity of parallel tests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Increasing the prevalence of disease ,[object Object],[object Object],[object Object]
Effect of prevalence on predictive value(Se=70%, Sp=90%) 93.0 50,000 Clinical suspicious prostatic nodule 5.6 500 Men, age 75or greater 0.4 35 General population PPV (%) Prevalence (case/100,000) Setting
Lead Time 1990 1997 2000 death Diagnosis and  treatment Biologic onset of disease 1990 1994 2000 death Biologic onset of disease Screening: diagnosis & treatment
Length Bias 1995 2000 death Biologic onset of disease 1989 1994 death Biologic onset of disease Screening: diagnosis & treatment 2002 1994 Screening:
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