Rodríguez-Álvarez María Xosé, Roca-Pardiñas Javier, Cadarso-Suárez Carmen, Tahoces Pablo G
1 Department of Statistics and Operations Research and Biomedical Research Centre, University of Vigo, Vigo, Spain.
2 BCAM - Basque Center for Applied Mathematics, Bilbao, Spain.
Stat Methods Med Res. 2018 Mar;27(3):740-764. doi: 10.1177/0962280217742542. Epub 2017 Dec 12.
Prior to using a diagnostic test in a routine clinical setting, the rigorous evaluation of its diagnostic accuracy is essential. The receiver-operating characteristic curve is the measure of accuracy most widely used for continuous diagnostic tests. However, the possible impact of extra information about the patient (or even the environment) on diagnostic accuracy also needs to be assessed. In this paper, we focus on an estimator for the covariate-specific receiver-operating characteristic curve based on direct regression modelling and nonparametric smoothing techniques. This approach defines the class of generalised additive models for the receiver-operating characteristic curve. The main aim of the paper is to offer new inferential procedures for testing the effect of covariates on the conditional receiver-operating characteristic curve within the above-mentioned class. Specifically, two different bootstrap-based tests are suggested to check (a) the possible effect of continuous covariates on the receiver-operating characteristic curve and (b) the presence of factor-by-curve interaction terms. The validity of the proposed bootstrap-based procedures is supported by simulations. To facilitate the application of these new procedures in practice, an R-package, known as npROCRegression, is provided and briefly described. Finally, data derived from a computer-aided diagnostic system for the automatic detection of tumour masses in breast cancer is analysed.
在常规临床环境中使用诊断测试之前,对其诊断准确性进行严格评估至关重要。接收者操作特征曲线是用于连续诊断测试的最广泛使用的准确性度量。然而,关于患者(甚至环境)的额外信息对诊断准确性的可能影响也需要进行评估。在本文中,我们专注于基于直接回归建模和非参数平滑技术的协变量特定接收者操作特征曲线的估计器。这种方法定义了接收者操作特征曲线的广义加性模型类。本文的主要目的是提供新的推断程序,用于检验协变量对上述类中条件接收者操作特征曲线的影响。具体而言,建议使用两种不同的基于自助法的检验来检查:(a)连续协变量对接收者操作特征曲线的可能影响,以及(b)因子与曲线交互项的存在情况。模拟结果支持了所提出的基于自助法程序的有效性。为便于这些新程序在实践中的应用,提供并简要描述了一个名为npROCRegression的R包。最后,对来自用于乳腺癌肿瘤肿块自动检测的计算机辅助诊断系统的数据进行了分析。