Sensitivity, specificity and ROC-curves in multiple reader diagnostic trials—A unified, nonparametric approach

In diagnostic trials, the performance of a product is most frequently measured in terms such as sensitivity, specificity and the area under the ROC-curve (AUC). In multiple-reader trials, correlated data appear in a natural way since the same patient is observed under different conditions by several readers. The repeated measures may have quite an involved correlation structure. Even though sensitivity, specificity and the AUC are all assessments of diagnostic ability, a unified approach to analyze all such measurements allowing for an arbitrary correlation structure does not exist. Thus, a unified approach for these three effect measures of diagnostic ability will be presented in this paper. The fact that sensitivity and specificity are particular AUCs will serve as a basis for our method of analysis. As the presented theory can also be used in set-ups with correlated binomial random-variables, it may have a more extensive application than only in diagnostic trials.