doi:10.1016/j.csda.2005.12.021
Copyright © 2006 Elsevier B.V. All rights reserved.
Estimators of sensitivity and specificity in the presence of verification bias: A Bayesian approach
aDepartamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP/USP). Av. Bandeirantes, 3900 - Ribeirão Preto CEP 14049-900, SP, Brazil
bDepartamento de Estatística, Universidade Federal de São Carlos (UFSCar). Caixa Postal 676 - São Carlos CEP 13565-905, SP, Brazil
Received 8 April 2005;
revised 22 December 2005;
accepted 31 December 2005.
Available online 20 January 2006.
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Abstract
Verification bias can occur if some of the patients with test results are not selected to receive the gold standard procedure. Unverified cases frequently are not suggestive to be positives. Consequently, the set of verified cases overestimates the number of true positives and underestimates the number of true negatives. The sensitivity and specificity estimates based only on the patients with verified disease are often biased. In this article we derive estimators for sensitivity and specificity not subject to verification bias using a Bayesian approach. Marginal posterior densities of all parameters are estimated using the Gibbs sampler algorithm. An application to the study of accuracy of Hybrid Capture II in the diagnosis of cervical intraepithelial neoplasia grades 2 and 3 illustrates the proposed methodology.
Keywords: Verification bias; Work-up bias; Diagnostic tests; Sensitivity; Specificity; Gibbs sampling
Table 1.
Absolute frequencies for cross-tabulation of the variables D and T

Table 2.
Probabilities in the cross-tabulation of the variables V, D and T

Table 3.
Distribution of HPV-DNA HC-II testing results by cervical lesion as ascertained by histological diagnosis

Table 4.
Posterior summaries. Panel (a) displays the results of using informative prior distributions for SE and SP in the fits to the data. Panel (b) displays posterior summaries when all prior distributions are noninformative with respect to the data. Panel (c) displays posterior summaries considering informative prior distributions for λ11, λ01, λ10 and λ00

SD: standard deviation.
Table 5.
Distribution of HPV-DNA HC-II testing results by age group and cervical lesion as ascertained by histological diagnosis

Table 6.
Posterior summaries, model with covariate

SD: standard deviation.
Table 7.
Posterior summaries for SE, SP, ξ,λ11, λ01, λ10 and λ00, by age group

SD: standard deviation.