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A novel method for interrogating receiver operating characteristic curves for assessing prognostic tests.

Grégoire Thomas1, Louise C Kenny2,3, Philip N Baker4

  • 1SQU4RE, 8800 Roeselare, Belgium.

Diagnostic and Prognostic Research
|May 17, 2019
PubMed
Summary

Novel prognostic tests often overlook disease prevalence, hindering clinical use. This study introduces a method to integrate positive and negative predictive values (PPV/NPV) into ROC analysis, improving clinical utility for risk stratification.

Keywords:
BiomarkersMulti-component testsPrognosisPrognostic performance

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Area of Science:

  • Medical Diagnostics
  • Biostatistics
  • Prognostic Modeling

Background:

  • Prognostic test development often neglects disease prevalence.
  • Area Under the Receiver Operating Characteristic Curve (AUROC) is a common but limited performance metric.
  • Lack of prevalence consideration impedes clinical translation of prognostic tests.

Purpose of the Study:

  • To present a method for incorporating positive predictive value (PPV) and negative predictive value (NPV) into Receiver Operating Characteristic (ROC) space.
  • To enhance the clinical relevance of prognostic test evaluation.
  • To facilitate the development of clinically useful prognostic tools.

Main Methods:

  • Derived equations for equi-PPV and equi-NPV lines to plot within ROC space.
  • Reviewed ROC analysis mechanics, strengths, and limitations.
  • Developed an interactive web tool for exploring predictive value criteria dynamics with prevalence.

Main Results:

  • Demonstrated a method to visualize PPV/NPV criteria alongside ROC curves.
  • Illustrated the concept with an example predicting pre-eclampsia risk.
  • Showcased how prevalence impacts prognostic test performance.

Conclusions:

  • Clinical utility of prognostic tests can be defined by PPV and NPV criteria.
  • Co-visualizing PPV/NPV criteria with ROC curves aids test development.
  • Separate tests for rule-in (PPV) and rule-out (NPV) may be needed for effective risk stratification.