Xiong Chengjie, van Belle Gerald, Miller J Philip, Yan Yan, Gao Feng, Yu Kai, Morris John C
Division of Biostatistics, Washington University in St. Louis, St. Louis, MO 63110, USA.
Biom J. 2007 Aug;49(5):682-93. doi: 10.1002/bimj.200610359.
Many medical diagnostic studies involve three ordinal diagnostic groups in which the diagnostic accuracy can be summarized by the volume or partial volume under a Receiver Operating Characteristic (ROC) surface. We study in this paper the statistical comparison of diagnostic accuracy from multiple diagnostic tests when three ordinal diagnostic groups are involved. Under the assumption that the multiple diagnostic tests follow a multivariate normal distribution within each diagnostic group, we provide the asymptotic variance and covariance for the maximum likelihood estimates of the volumes under the ROC surfaces from multiple diagnostic tests and propose statistical tests to test whether the diagnostic accuracy as measured by the volume under the ROC surface is the same for multiple diagnostic tests. We also propose a confidence interval estimate to the difference of two volumes under two ROC surfaces. Our approach depends crucially on the assumptions of normal distributions on diagnostic tests, which might not be robust when such assumptions are violated. Finally, we apply our proposed methodology to a real data set of 118 subjects to compare the diagnostic accuracy of early stage Alzheimer's disease (AD) from multiple neuropsychological tests.
许多医学诊断研究涉及三个有序诊断组，其中诊断准确性可以通过接受者操作特征（ROC）曲面下的体积或部分体积来概括。本文研究当涉及三个有序诊断组时，多个诊断测试的诊断准确性的统计比较。在每个诊断组内多个诊断测试遵循多元正态分布的假设下，我们提供了多个诊断测试的ROC曲面下体积的最大似然估计的渐近方差和协方差，并提出统计检验以检验多个诊断测试中由ROC曲面下体积衡量的诊断准确性是否相同。我们还提出了两个ROC曲面下两个体积差异的置信区间估计。我们的方法关键取决于诊断测试的正态分布假设，当这些假设被违反时可能不够稳健。最后，我们将所提出的方法应用于118名受试者的真实数据集，以比较多种神经心理学测试对早期阿尔茨海默病（AD）的诊断准确性。
