Validity Of A Screening Test

Dr Sumit Kar
Professor ,Community Medicine
 Plan of Presentation
• Definitions
• Objective
• Sensitivity & Specificity
• Concept of false positives and false negatives
• Tests for continuous variables
• Combination of tests and effects
• Predictive value of a test
• Determining cut-off point
• ROC curve
 Definition
• The process by which unrecognized disease or defects
are identified by means of rapidly applied tests,
examination or other procedures in apparently
healthy individuals on a large scale.
• Differs from periodic health exam as:

Capable of wide application

Relatively inexpensive
Physician has to only interpret it and hence
saves time
 Aims and Objectives
• To sort out from a large group of apparently
healthy people, those likely to have disease or
are at an increased risk.
• To bring those who are apparently abnormal
under supervision, confirmation and
treatment if required.
Three Key Measures of Validity

1. SENSITIVITY
2. SPECIFICITY
3. PREDICTIVE VALUE
 Validity of Screening Tests
• The validity of a screening test is defined as its
ability to distinguish between who has a disease
and who does not and has 2 components:
• Sensitivity : defined as ability of a test to
identify correctly those who have the disease or
true positives.
• Specificity : defined as the ability of a test to
identify correctly those who do not have a
disease or true negatives.
Comparison of the results of a Dichotomous test with
disease status
True characteristics in the population
 Sensitivity
• It is defined as the ability of a test to identify
correctly all those who have the disease, that is
“true positive".

• A test has 90% sensitivity means: 90 per cent of

the diseased people screened by the test will
give a "true positive" result and the remaining
10 per cent a "false negative" result.
Specificity
Percentage of False Positives:
Percentage of False Negatives:
Predictive Values of A Test :
Negative Predictive Value:
• Sensitivity = a/a + c = 48/50 = 96%
• Specificity = d/ d + b = 47/50 = 94%
• Positive predictive value = a/a + b x 100
= 48/51 = 94%
• Negative predictive value = d/c + d x 100
= 47/49 = 96%
 Effect of Prevalence :
• Predictive values depend strongly on
prevalence of the
condition.
• As the prevalence of the condition increases
positive predictive value increases and thus
more chances of getting true positive results.
• If the condition is uncommon it is more sure
that the negative test indicates no abnormality.
Relationship B/W Predictive Value And
Disease Prevalence

Higher the prevalence, higher is the predictive value.

Hence a screening program is most productive and
efficient when it is directed to high risk target population.
Yield
 Homework
• A physical examination was used to screen for breast
cancer in 2500 women with biopsy –proven adeno-
carcinoma of the breast and in 5000 age and race-match
control women. The results of the physical examination
were positive ( ie, a mass was palpated) in 1800 cases
and in 800 control women, all of whom showed no
evidence of cancer at biopsy.
• What was the sensitivity and specificity of the Physical
examination ?
• Find out the positive predictive value of the physical
examination
 Home work
• A physical examination and an audiometric test were given to 500 persons
with suspected hearing loss, of whom 300 were actually found to have it.
The results of the examination were as follows-
• Physical examination:

Results Hearing problems

Present Absent
Positive 240 (a) 40 (b)
Negative 60 (c) 160 (d)

• Audiometric test:

Results Hearing problems

Present Absent
Positive 270 (a) 60 (b)
Negative 30 (c) 140 (d)
• Compare with physical examination whether
the audiometric test is:
a). Equally sensitive and specific
b). Less sensitive and less specific
c). Less sensitive and more specific
d). More sensitive and less specific
e).More sensitive and more specific