McNemar χ2 test revisited:: comparing sensitivity and specificity of diagnostic examinations
McNemar χ2 test revisited:: comparing sensitivity and specificity of diagnostic examinations
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DOI：
10.1080/00365510701666031
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发表时间：
2008-01-01
影响因子：
2.1
通讯作者：
Luiz, R. R.
中科院分区：
文献类型：
--
作者：
Trajman, A.;Luiz, R. R.
当评估用于临床的新型诊断检查时，应将其与参考标准进行比较，参考标准定义为可获得的最佳检查，可能包括临床和实验室标准。新的检查和参考标准的结果通常以2 × 2表格的形式呈现，以便计算灵敏度、特异性和准确性。在评估诊断检查的准确性时，建议报告统计不确定性的度量，例如95%置信区间。在评估新检查的有效性时，比较新检查与参考标准在灵敏度或特异性上的差异是很重要的。McNemar chi(2)检验用于比较两个二分反应的不一致性，可用于此目的。然而，不建议将McNemar试验应用于2 × 2表格来比较检查的准确性，因为该试验对阳性和阴性受试者的比例很敏感。此外，如果新检查的灵敏度高于作为参考标准的检查，则构建经典的2 × 2表将导致新检查的特异性较低。因此，为了比较不同检查之间的敏感性和特异性，这个表是不合适的，需要一个独立的参考标准。在这篇文章中，我们建议使用McNemar chi(2)测试来比较在患病患者中使用2 × 2表的检查之间的敏感性，这些检查由一套标准和患者随访定义。同样，在健康个体中应用McNemar测试可以比较特异性。
When evaluating a novel diagnostic examination for clinical use, it should be compared with a reference standard, defined as the best available examination, which may include clinical and laboratory criteria. The novel examination and reference standard's results are usually presented in the form of a 2 x 2 table, which allows calculation of sensitivity, specificity and accuracy. It has been recommended that the measures of statistical uncertainty should be reported, such as the 95% confidence interval, when evaluating the accuracy of diagnostic examinations. Comparing the difference in sensitivity or specificity of a novel examination with the reference standard is important when evaluating its usefulness. The McNemar chi(2) test, used to compare discordance of two dichotomous responses, can be applied for this purpose. However, applying the McNemar test to a 2 x 2 table for comparing the accuracy of examinations is not recommended, since this test is sensitive to the proportion of positive versus negative subjects. Moreover, if the novel examination has higher sensitivity than the one considered as the reference standard, constructing a classic 2 x 2 table would result in low specificity of the novel examination. Thus, in order to compare sensitivities and specificities between examinations, this table is inappropriate and an independent reference standard is necessary. In this article, we propose the use of the McNemar chi(2) test to compare sensitivities between examinations using a 2 x 2 table exclusively among diseased patients, defined by a set of criteria and follow-up of patients. Likewise, specificities can be compared applying the McNemar test among healthy individuals.