10/17/2017 Interpreting results: ROC curves

GraphPad Statistics Guide

Interpreting results: ROC curves

Sensitivity and specificity

The whole point of an ROC curve is to help you decide where to draw the line between 'normal' and 'not
normal'. This will be an easy decision if all the control values are higher (or lower) than all the patient values.
Usually, however, the two distributions overlap, making it not so easy. If you make the threshold high, you
won't mistakenly diagnose the disease in many who don't have it, but you will miss some of the
people who have the disease. If you make the threshold low, you'll correctly identify all (or almost all)
of the people with the disease, but will also diagnose the disease in more people who don't have it.
To help you make this decision, Prism tabulates and plots the sensitivity and specificity of the test at various
cut-off values.
Sensitivity: The fraction of people with the disease that the test correctly identifies as positive.
Specificity: The fraction of people without the disease that the test correctly identifies as negative.
Prism calculates the sensitivity and specificity using each value in the data table as the cutoff value. This
means that it calculates many pairs of sensitivity and specificity. If you select a high threshold, you increase
the specificity of the test, but lose sensitivity. If you make the threshold low, you increase the test's
sensitivity but lose specificity.
Prism displays these results in two forms. The table labeled "ROC" curve is used to create the graph of 100%-
Specificity% vs. Sensitivity%. The table labeled "Sensitivity and Specifity" tabulates those values along with
their 95% confidence interval for each possible cutoff between normal and abnormal.

Area
The area under a ROC curve quantifies the overall ability of the test to discriminate between those individuals
with the disease and those without the disease. A truly useless test (one no better at identifying true positives
than flipping a coin) has an area of 0.5. A perfect test (one that has zero false positives and zero false
negatives) has an area of 1.00. Your test will have an area between those two values. Even if you choose to
plot the results as percentages, Prism reports the area as a fraction.
Prism computes the area under the entire AUC curve, starting at 0,0 and ending at 100, 100. Note that
whether or not you ask Prism to plot the ROC curve out to these extremes, it computes the area for that entire
curve.
While it is clear that the area under the curve is related to the overall ability of a test to correctly identify normal
versus abnormal, it is not so obvious how one interprets the area itself. There is, however, a very intuitive
interpretation.
If patients have higher test values than controls then:

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