Beyond sensitivity and specificity: Survival in the managed care arena
✍ Scribed by Michael B. Cohen; Stephen S. Raab
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 236 KB
- Volume
- 14
- Category
- Article
- ISSN
- 8755-1039
No coin nor oath required. For personal study only.
✦ Synopsis
In 1975, Galen and Gambino published a monograph entitled, Beyond Normality: The Predictive Value and Eficiency of Medical Diagnoses. ' This monograph received much attention, in part because it helped to introduce to a wider audience the concepts of sensitivity and specificity and the related concepts of positive and negative predictive values. In short, this monograph became a reference standard when reporting results based on cytologic material. In this editorial, we would like to provide an overview of additional statistical methods for analysis which are very appropriate for cytopathology and which build upon the earlier work introduced by Galen and Gambino. As a paradigm, we would like to use the excellent book by Sackett et al., Clinical Epidemiology: A Basic Science for Clinical Medicine. In that book, a systematic approach is utilized with increasingly complex ways of analyzing data. Beginning with a yellow belt, referred to as analyzing with pictures, Chapter 4 progresses through additional belt colors to ultimately arrive at a black belt, which is based on an analysis which requires a hand calculator at minimum, and forms the basis of decision analysis, one of the more prominent forms of outcomes analysis.
Yellow Belt
Briefly, analyzing with a yellow belt requires the establishment of rule in and rule out c u t -o k 2 While this is a simple task for clinical laboratory tests, such as serum levels of various metabolites, enzymes, etc., it is more difficult to apply to cytopathology. Clearly, the discrimination between normal and abnormal, i.e., benign and malignant, depends on a criterion (or criteria) which in the ideal setting would show absolute resolution between these two conditions. In reality, however, there is overlap and cut-offs must be established. The use of cut-offs, in