Classifying Binormal Diagnostic Tests Using Separation - Asymmetry Diagrams with Constant-performance Curves

A method is proposed for classifying diagnostic tests that have underlying binormal distri butions. The method involves using the parameters that characterize these distributions as axes of a two-dimensional graph called a separation-asymmetry (S-A) diagram. Each point on an S-A diagram corresponds to a possible diagnostic test. The diagram also has super imposed on it any of three possible families of curves of constant performance: curves of constant area under the ROC graph (iso-AUR), curves of constant overlap area (iso-OA), and curves of constant maximum information (iso-MaxInfo). Thus, the performance of any test can be determined immediately by identifying the iso-performance curve of the desired type that passes through the corresponding point of the S-A diagram. The concept of "ec centric" diagnostic tests is defined and incorporated into the S-A diagrams. The classification scheme is applied to 28 diagnostic tests. Excellent agreement is found in the ranking between the iso-OA and iso-MaxInfo measures of performance, but the iso-AUR produces markedly different results. Only three of the 28 tests were found to be eccentric. Several other inter esting patterns emerged. Key words: diagnostic tests; separation-asymmetry diagrams; test efficacy; information theory; receiver operator characteristic analysis. (Med Decis Making 1994;14:157-168)

[1]  B. Carroll,et al.  EEG studies of sleep in the diagnosis of depression. , 1982, Biological psychiatry.

[2]  K P Offord,et al.  A short test of mental status: description and preliminary results. , 1987, Mayo Clinic proceedings.

[3]  J Desmyter,et al.  EVALUATION OF SIX ENZYME IMMUNOASSAYS FOR ANTIBODY AGAINST HUMAN IMMUNODEFICIENCY VIRUS , 1986, The Lancet.

[4]  A. Rush,et al.  Sleep EEG and dexamethasone suppression test findings in outpatients with unipolar major depressive disorders. , 1982, Biological psychiatry.

[5]  C E Metz,et al.  Evaluation of receiver operating characteristic curve data in terms of information theory, with applications in radiography. , 1973, Radiology.

[6]  E. Somoza,et al.  Comparing and Optimizing Diagnostic Tests , 1992, Medical decision making : an international journal of the Society for Medical Decision Making.

[7]  Douglas Mossman,et al.  Assessing improvements in the Dexamethasone Suppression Test using receiver operating characteristic analysis , 1989, Biological Psychiatry.

[8]  Magnetic resonance imaging, computed tomography, and radionuclide scintigraphy in detection of liver metastases. , 1988, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[9]  B. Carroll,et al.  A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. , 1981, Archives of general psychiatry.

[10]  M B Gardner,et al.  AIDS serology testing in low- and high-risk groups. , 1985, JAMA.

[11]  J. Mendlewicz,et al.  The Dexamethasone Suppression Test in Affective Disorder , 1982, British Journal of Psychiatry.

[12]  E. Perry,et al.  Biochemical assay of Alzheimer's disease--associated protein(s) in human brain tissue. A clinical study. , 1990, JAMA.

[13]  Douglas Mossman,et al.  Optimizing REM latency as a diagnostic test for depression using receiver operating characteristic analysis and information theory , 1990, Biological Psychiatry.

[14]  H. Matsunaga,et al.  Low-dose (0.5-mg) dexamethasone suppression test in depressive patients , 1986, Biological Psychiatry.

[15]  J A Swets,et al.  Form of empirical ROCs in discrimination and diagnostic tasks: implications for theory and measurement of performance. , 1986, Psychological bulletin.

[16]  C. Metz.  Basic principles of ROC analysis. , 1978, Seminars in nuclear medicine.

[17]  D. M. Green,et al.  Signal detection theory and psychophysics , 1966 .

[18]  D Mossman,et al.  Maximizing diagnostic information from the dexamethasone suppression test. An approach to criterion selection using receiver operating characteristic analysis. , 1989, Archives of general psychiatry.

[19]  R. Fieve,et al.  The dexamethasone suppression test in depressed outpatients and normal control subjects. , 1983, The American journal of psychiatry.

[20]  F. Goodwin,et al.  Depressed patients have decreased binding of tritiated imipramine to platelet serotonin "transporter". , 1981, Archives of general psychiatry.

[21]  D Mossman,et al.  Neuropsychiatric decision making: designing nonbinary diagnostic tests. , 1991, The Journal of neuropsychiatry and clinical neurosciences.

[22]  F. Schaffner,et al.  Carbohydrate-deficient transferrin, a marker for chronic alcohol consumption in different ethnic populations. , 1988, Alcoholism, clinical and experimental research.

[23]  M. Berger,et al.  Neuroendocrinological and neurophysiological studies in major depressive disorders: are there biological markers for the endogenous subtype? , 1982, Biological psychiatry.

[24]  J. Goedert,et al.  Screening test for HTLV-III (AIDS agent) antibodies: specificity, sensitivity, and applications. , 1985, JAMA.

[25]  N. Nair,et al.  Platelet 3H-imipramine binding distinguishes depression from Alzheimer dementia. , 1985, Life sciences.

[26]  J A Swets,et al.  Measuring the accuracy of diagnostic systems. , 1988, Science.

[27]  P. Linkowski,et al.  Dexamethasone Suppression Test and REM Sleep in Patients with Major Depressive Disorder , 1984, British Journal of Psychiatry.

[28]  E. Cook,et al.  Evaluation of creatine kinase and creatine kinase-MB for diagnosing myocardial infarction. Clinical impact in the emergency room. , 1987, Archives of internal medicine.

[29]  C. Nemeroff,et al.  Marked reduction in the number of platelet-tritiated imipramine binding sites in geriatric depression. , 1988, Archives of general psychiatry.

[30]  Douglas Mossman,et al.  “Biological markers” and psychiatric diagnosis: risk-benefit balancing using ROC analysis , 1991, Biological Psychiatry.

[31]  E. Somoza,et al.  ROC curves and the binormal assumption. , 1991, The Journal of neuropsychiatry and clinical neurosciences.

[32]  J. Gohagan,et al.  ROC analysis of mammography and palpation for breast screening. , 1984, Investigative radiology.

[33]  J. Swets.  ROC analysis applied to the evaluation of medical imaging techniques. , 1979, Investigative radiology.

[34]  J. Hanley.  The Robustness of the "Binormal" Assumptions Used in Fitting ROC Curves , 1988, Medical decision making : an international journal of the Society for Medical Decision Making.

[35]  E Somoza,et al.  Evaluation and optimization of diagnostic tests using receiver operating characteristic analysis and information theory. , 1989, International journal of bio-medical computing.

[36]  E. Somoza,et al.  Comparing diagnostic tests using information theory: the INFO-ROC technique. , 1992, The Journal of neuropsychiatry and clinical neurosciences.

[37]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[38]  Diagnostic tests and information theory. , 1992, The Journal of neuropsychiatry and clinical neurosciences.

[39]  Introduction to neuropsychiatric decision making: binary diagnostic tests. , 1990, The Journal of neuropsychiatry and clinical neurosciences.

[40]  H. Akiskal,et al.  The utility of the REM latency test in psychiatric diagnosis: A study of 81 depressed outpatients , 1982, Psychiatry Research.

[41]  A. Coppen,et al.  Dexamethasone Suppression Test in Depression and other Psychiatric Illness , 1983, British Journal of Psychiatry.

[42]  M. Briley,et al.  Tritiated imipramine binding sites are decreased in platelets of untreated depressed patients. , 1980, Science.