Gabe S. Sonke, MD, PhD; André L.M. Verbeek, MD, PhD; Lambertus A.L.M. Kiemeney, PhD
Potential Financial Conflicts of Interest: None disclosed.
Sonke GS, Verbeek AL, Kiemeney LA. A Philosophical Approach to Diagnostic Test Evaluation. Ann Intern Med. 2007;146:757. doi: 10.7326/0003-4819-146-10-200705150-00015
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Published: Ann Intern Med. 2007;146(10):757.
TO THE EDITOR:
In their recent article, Lord and colleagues (1) propose a framework to decide when measuring diagnostic test accuracy is sufficient to evaluate a diagnostic test and when a randomized trial is needed. Their work, in accordance with most previous papers on the subject, considers accuracy and patient outcome studies as separate phases in the evaluation of a diagnostic test: Accuracy studies show how well a diagnostic test identifies the true presence or absence of disease, and patient outcome studies show whether a patient classification based on the new test better predicts patient outcome. We feel that this phased evaluation of diagnostic tests lacks appreciation of the fact that disease, by definition, is a prognostic statement and that, consequently, accuracy studies cannot be interpreted independent of patient outcome.
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