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Activity Number: 410 - Diagnostic Tests: Regulatory Considerations of Intermediate Outputs and Oncology Screening, and Optimal Point of Heterogeneous ROC Curves
Type: Contributed
Date/Time: Tuesday, July 30, 2019 : 2:00 PM to 3:50 PM
Sponsor: Section on Medical Devices and Diagnostics
Abstract #307222
Title: ROC Analysis for Multistage Diagnostic Testing Procedures in the Presence of Indeterminate Results
Author(s): Ziqiang Chen* and Gregory Wilding
Companies: State University of New York At Buffalo and SUNY at Buffalo
Keywords: Diagnostic test; Indeterminate results; ROC analysis

Several methods have been proposed for defining indeterminate testing results to reduce erroneous decisions. All methods approach the problem without consideration of the likely retesting in practice when a given test result is deemed indeterminate. We argue that the analysis should better reflect the actual use of the developed diagnostic test. Suppose a multistage diagnostic testing algorithm is considered where a given test may be used up to k times sequentially for a given patient, with additional testing only taking place if the result from the previous stage is indeterminate. We propose that for stages less than k, two thresholds be defined corresponding to positive, negative, and indeterminate result. For the kth stage, where a final result is required, a single threshold is defined. A generalization of the ROC and corresponding area under the curve is constructed by considering all possible values of thresholds. We evaluate the properties of the proposed method via simulation studies and results show superior performance compared to the typical ROC-based approaches, with the improvement being more substantial as k increases. An application is considered for the case of k=2.

Authors who are presenting talks have a * after their name.

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