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1.
The performance of a new diagnostic test is frequently evaluated by comparison to a perfect reference test (i.e. a gold standard). In many instances, however, a reference test is less than perfect. In this paper, we review methods for estimation of the accuracy of a diagnostic test when an imperfect reference test with known classification errors is available. Furthermore, we focus our presentation on available methods of estimation of test characteristics when the sensitivity and specificity of both tests are unknown. We present some of the available statistical methods for estimation of the accuracy of diagnostic tests when a reference test does not exist (including maximum likelihood estimation and Bayesian inference). We illustrate the application of the described methods using data from an evaluation of a nested polymerase chain reaction and microscopic examination of kidney imprints for detection of Nucleospora salmonis in rainbow trout.  相似文献   

2.
OBJECTIVE: To estimate sensitivity and specificity of 4 commonly used brucellosis screening tests in cattle and domestic water buffalo of Trinidad, and to compare test parameter estimates between cattle and water buffalo. ANIMALS: 391 cattle and 381 water buffalo. PROCEDURE: 4 Brucella-infected herds (2 cattle and 2 water buffalo) and 4 herds (2 of each species) considered to be brucellosis-free were selected. A minimum of 100 animals, or all animals > 1 year of age, were tested from each herd. Serum samples were evaluated for Brucella-specific antibodies by use of standard plate agglutination test (SPAT), card test (CT), buffered plate agglutination test (BPAT), and standard tube agglutination test (STAT). A Bayesian approach was used to estimate sensitivity and specificity of diagnostic tests without the use of a gold standard, assuming conditional independence of tests. RESULTS: Sensitivity and specificity estimates in cattle, respectively, were SPAT, 66.7 and 98.9; CT, 72.7 and 99.6; BPAT, 88.1 and 98.1; and STAT, 80.2 and 99.3. Corresponding test estimates in water buffalo, respectively, were SPAT, 51.4 and 99.3; CT, 90.4 and 99.4; BPAT, 96.3 and 90.7; and STAT, 75.0 and 98.8. Sensitivity of the CT and specificity of the BPAT were different between cattle and water buffalo with at least 95% probability. CONCLUSIONS AND CLINICAL RELEVANCE: Brucellosis serologic test performance varied by species tested, but BPAT had the highest sensitivity for screening cattle and water buffalo. Sensitivity and specificity of more than 2 screening tests can be estimated simultaneously without a gold standard by use of Bayesian techniques.  相似文献   

3.
Application of diagnostic tests in veterinary epidemiologic studies   总被引：3，自引：0，他引：3  
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4.
Studies that report the sensitivity and specificity of diagnostic tests are susceptible to flaws that can introduce bias and lead to incorrect estimates. This article uses the quality assessment of diagnostic accuracy studies checklist to describe how to appraise a study reporting diagnostic test comparisons critically. The article also contains a glossary of terms that are useful in discussions about diagnostic tests.  相似文献   

5.
When a perfect reference test (i.e. "gold standard") is not available, it is possible to obtain estimates of test sensitivity and specificity using "latent-class" methods. However, there are few widely available software programs that allow implementation of these procedures. We describe the development of a program (implemented in R and S-Plus software) for this purpose that yields maximum-likelihood estimates of sensitivity, specificity and prevalence. We also have implemented an HTML form, which submits data to a web-based interface to R. The programs can incorporate data obtained from several populations, results of multiple tests, and can account for data obtained from a reference population in which the true status (infected or non-infected) of each individual is known exactly. Two estimation methods are used: a Newton-Raphson procedure and an expectation-maximisation (EM) procedure. The estimation methods assume test independence conditional on the infection status of the individuals and constant test accuracy in each population. A goodness-of-fit statistic and the residuals of pairwise correlation coefficients are calculated to check the validity of these assumptions. Two examples are used to illustrate application and limitations of the programs. The programs are available at www.afssa.fr/interne/tags.htm (Europe) or www.epi.ucdavis.edu/diagnostictests/ (USA).  相似文献   

6.
Considerable effort has been devoted to improving the existing diagnostic tests for bovine tuberculosis (single intradermal comparative tuberculin test [SICTT] and γ-interferon assay [γ-IFN]) and to develop new tests. Previously, the diagnostic characteristics (sensitivity, specificity) have been estimated in populations with defined infection status. However, these approaches can be problematic as there may be few herds in Ireland where freedom from infection is guaranteed. We used latent class models to estimate the diagnostic characteristics of existing (SICTT and γ-IFN) and new (multiplex immunoassay [Enferplex-TB]) diagnostic tests under Irish field conditions where true disease status was unknown. The study population consisted of herds recruited in areas with no known TB problems (2197 animals) and herds experiencing a confirmed TB breakdown (2740 animals). A Bayesian model was developed, allowing for dependence between SICTT and γ-IFN, while assuming independence from the Enferplex-TB test. Different test interpretations were used for the analysis: SICTT (standard and severe interpretation), γ-IFN (a single interpretation), and a range of interpretations for the Enferplex-TB (level-1 [high sensitivity interpretation] to level-5 [high specificity interpretation]). The sensitivity and specificity (95% posterior credibility intervals; 95% PCI) of SICTT[standard] relative to Enferplex-TB[level-1] and γ-IFN were 52.9-60.8% and 99.2-99.8%, respectively. Equivalent estimates for γ-IFN relative to Enferplex-TB[level-1] and SICTT were 63.1-70.1% and 86.8-89.4%, respectively. Sensitivity of Enferplex-TB[level-1] (95% PCI: 64.8-71.9%) was superior to the SICTT[standard], and specificity of the Enferplex-TB[level-5] was superior to γ-IFN (95% PCI: 99.6-100.0%). These results provide robust measures of sensitivity and specificity under field conditions in Ireland and suggest that the Enferplex-TB test has the potential to improve on current diagnostics for TB infection in cattle. The extent of that potential will be assessed in further studies.  相似文献   

7.
Serological methods are traditionally used in diagnosis of brucellosis. However, the comparative performance of these tests and their accuracy under the local environment in Zambia has not been assessed. Thus, the objective of our study was to evaluate the diagnostic performance of three serological tests for brucellosis; Rose Bengal Test (RBT), competitive ELISA (c-ELISA) and Fluorescence Polarisation Assay (FPA) in naturally infected cattle in Zambia without an appropriate reference test to classify animals into truly infected and non-infected. Serological test results from a study to determine sero-prevalence were used to compare the performance of RBT, c-ELISA and FPA in diagnosing brucellosis in traditional cattle. Since none of the tests can be seen as a perfect reference test or gold standard, their performance in a population of naturally infected cattle was evaluated using latent class analysis which allows the sensitivity (Se) and specificity (Sp) to be estimated in the absence of a gold standard. The highest Se was achieved by the c-ELISA (97%; Credible Posterior Interval (CPI)=93-100%) and the highest Sp by the FPA (93%; CPI=85-99%), conversely these tests also had the lowest Sp and Se, respectively, with the RBT performing well in both the Se (93%; CPI=84-98%) and Sp (81%; CPI=61-97).  相似文献   

8.
An enzyme-linked immunosorbent assay (ELISA) using a puma lentivirus-derived synthetic peptide as coating antigen was evaluated as a diagnostic test for infection with feline immunodeficiency virus (FIV) or related lentiviruses in free-ranging lions. The sensitivity and specificity of the ELISA was determined using two approaches. In the first approach, the results were standardized according to certain statistical criteria, and in the second, the puma lentivirus western blot was used as the gold standard. The sensitivity of the test when compared with the standardized results was 85.4% and the specificity 100%. The sensitivity of the test when using the western blot as the gold standard was 78.6% and the specificity 100%. The test would therefore be well-suited to the screening of populations of wild felids in which FIV or related lentiviruses are endemic. The results also indicate that in spite of genetic divergence between lentiviruses isolated from Panthera and Felis spp., puma lentivirus-derived antigens can be used in immunoassays for the detection of antibodies in Panthera spp. reactive to FIV or related lentiviruses. The results also indicate that the lion population in the Hluhluwe-Umfolozi Game Reserve, South Africa is lentivirus negative.  相似文献   

9.
Canine leishmaniasis caused by Leishmania chagasi (L. infantum) is found throughout the South American continent, including Brazil, and dogs are considered to be the main reservoir host for this parasite. To support the implementation of a diagnostic protocol for surveillance of the disease in the region of Belo Horizonte (Minas Gerais, Brazil) we have compared the sensitivity and specificity of two serological tests, indirect immunofluorescent antibody test (IFAT) and direct agglutination test (DAT), with the combination of direct microscopy–culture–PCR as the gold standard, using samples obtained from 103 dogs in the city of Belo Horizonte, Minas Gerais. The currently used standard serodiagnostic test, IFAT, had a sensitivity of 100% and its specificity was 74% compared to the gold standard of the study. The sensitivity and specificity of the DAT were 100% and 91%, respectively. On the basis of this study it is recommended to change from the IFAT to DAT for the serodiagnosis of canine leishmaniasis because of the superior specificity of the test combined with its user-friendliness.  相似文献   

10.
Estimation of the intracluster correlation coefficient (ICC) for infectious animal diseases may be of interest for survey planning and for calculating variance inflation factors for estimators of prevalence. Typically, diagnostic tests with imperfect sensitivity and specificity are used in surveys. In such studies, where animals from multiple herds are tested, the ICC often is estimated using apparent (test-based) rather than true prevalence data. Through Monte Carlo simulation, we examined the effect of substituting diagnostic test outcomes for true infection status on an ANOVA estimator of ICC, which was designed for use with true infection status data. We considered effects of diagnostic test sensitivity and specificity on the estimated ICC when the true ICC value and infection status of the sampled individuals were known. The ANOVA estimator underestimated the true ICC when the diagnostic test was imperfect. We also demonstrated, under the beta-binomial model, that the ICC based on apparent infection status for individuals is < or = ICC based on true infection status. In addition, we propose a Bayesian model for estimating the ICC that incorporates imperfect sensitivity and specificity and illustrate the Bayesian model using a simulation study and one example; a seroprevalence survey of ovine progressive pneumonia in U.S. sheep flocks.  相似文献   

11.
BACKGROUND: Screening tests for feline retroviruses are thought to have high sensitivity and specificity, although previous studies that evaluated these tests have limitations. Novel statistical approaches have been developed that allow the estimation of sensitivity and specificity in situations where the true state of the disease in individual animals cannot be assured. OBJECTIVE: The purpose of this study was to evaluate the sensitivity and specificity of a variety of retrovirus tests, including some screening tests, in a population of cats potentially infected with either feline leukemia virus (FeLV) and/or feline immunodeficiency virus (FIV) by using a Bayesian statistical approach. METHODS: Four hundred and ninety blood samples from cats being evaluated for FIV infection were tested by 2 rapid immunomigration tests (Witness single [WS], Witness combi [WC]) and a plate-based ELISA (Petcheck) for FIV antibody, and by a newly designed real-time polymerase chain reaction (PCR) assay for FIV provirus. Four hundred and ninety-five blood samples from cats being evaluated for FeLV infection were tested by 2 rapid immunomigration tests (WS, WC) and a plate-based ELISA (Petcheck) for FeLV antigen, and by a FeLV virus isolation technique. Results were then analyzed by using a Bayesian statistical method. RESULTS: For FIV tests, median sensitivity estimates were 0.98 for WS, 0.97 for WC, 0.98 for ELISA, and 0.92 for PCR. Median specificity estimates were 0.96 for WS, 0.96 for WC, 0.93 for ELISA, and 0.99 for PCR. For FeLV tests, median sensitivity estimates were 0.97 for WS, 0.97 for WC, 0.98 for ELISA, and 0.91 for virus isolation. Median specificity estimates were 0.96 for WS, 0.96 for WC, 0.98 for ELISA, and 0.99 for virus isolation. CONCLUSIONS: The use of Bayesian statistical methods overcomes a variety of methodologic problems associated with diagnostic test evaluations, including the lack of a definitive reference test. The sensitivity and the specificity of all 6 evaluated screening tests was high: however, specificity estimates were slightly lower than those reported by most recent studies.  相似文献   

12.
Test-and-slaughter strategies have been the basis of bovine tuberculosis (BT) eradication programs worldwide; however, eradication efforts have not succeeded in certain regions, and imperfect sensitivity and specificity of applied diagnostic techniques have been deemed as one of the possible causes for such failure. Evaluation of tuberculosis diagnostic tools has been impaired by the lack of an adequate gold standard to define positive and negative individuals. Here, a Bayesian approach was formulated to estimate for the first time sensitivity (Se) and specificity (Sp) of the tests [single intradermal tuberculin (SIT) test, and interferon-gamma (IFN-γ) assay] currently used in Spain. Field data from the first implementation of IFN-γ assay (used in parallel with SIT test 2-6months after a first disclosure SIT test) in infected beef, dairy and bullfighting cattle herds from the region of Castilla and Leon were used for the analysis. Model results suggested that in the described situation: (i) Se of SIT test was highly variable (40.1-92.2% for severe interpretation, median=66-69%), and its Sp was high (>99%) regardless interpretation criteria; (ii) IFN-γ assay showed a high Se (median=89-90% and 83.5% for 0.05 and 0.1 cut-off points respectively) and an acceptable Sp (85.7% and 90.3% for 0.05 and 0.1 thresholds) and (iii) parallel application of both tests maximized the combined Se (95.6% using severe SIT and 0.05 cut-off point in the IFN-γ assay). These results support the potential use of the IFN-γ assay as an ancillary technique for routine BT diagnosis.  相似文献   

13.
We propose a herd-level sample-size formula based on a common adjustment for prevalence estimates when diagnostic tests are imperfect. The formula depends on estimates of herd-level sensitivity and specificity. With Monte Carlo simulations, we explored the effects of different intracluster correlations on herd-level sensitivity and specificity. At low prevalence (e.g. 1% of animals infected), herd-level sensitivity increased with increasing intracluster correlation and many herds were classified as positive based only on false-positive test results. Herd-level sensitivity was less affected at higher prevalence (e.g. 20% of animals infected). A real-life example was developed for estimating ovine progressive pneumonia prevalence in sheep. The approach allows researchers to balance the number of herds and the total number of animals sampled by manipulating herd-level test characteristics (such as the number of animals sampled within a herd).  相似文献   

14.
在无"金标准"的情况下,为评估虎红平板凝集试验(RBT)、荧光偏振分析法(FPA)和间接酶联免疫吸附试验(I-ELISA)用于奶牛布鲁氏菌病的抗体检测能力,作者分别以RBT、FPA、I-ELISA3种方法对采自某奶牛场的血清样品进行检测,通过贝叶斯分析法对检测结果进行分析,研究3种方法检测奶牛布鲁氏菌血清抗体的敏感性(Se)和特异性(Sp)。结果显示,RBT、FPA、I-ELISA3种检测方法的敏感性(Se)分别为91.81%、95.92%和95.98%;特异性(Sp)分别为98.80%、86.54%和98.65%。本研究表明,3种血清学检测方法中以I-ELISA的检测能力最好。  相似文献   

15.
Although frequentist approaches to prevalence estimation are simple to apply, there are circumstances where it is difficult to satisfy assumptions of asymptotic normality and nonsensical point estimates (greater than 1 or less than 0) may result. This is particularly true when sample sizes are small, test prevalences are low and imperfect sensitivity and specificity of diagnostic tests need to be incorporated into calculations of true prevalence. Bayesian approaches offer several advantages including direct computation of range-respecting interval estimates (e.g. intervals between 0 and 1 for prevalence) without the requirement of transformations or large-sample approximations, direct probabilistic interpretation, and the flexibility to model in a straightforward manner the probability of zero prevalence. In this review, we present frequentist and Bayesian methods for animal- and herd-level true prevalence estimation based on individual and pooled samples. We provide statistical methods for detecting differences between population prevalence and frequentist methods for sample size and power calculations. All examples are motivated using Mycobacterium avium subspecies paratuberculosis infection and we provide WinBUGS code for all examples of Bayesian estimation.  相似文献   

16.
The sensitivity and specificity of six ELISA tests for foot-and-mouth disease (FMD) to discriminate between sero-converted (for non-structural FMD virus proteins) and non-sero-converted cattle were evaluated for vaccinated and unvaccinated cattle. Since none of the tests could be considered as a proper reference test and for about half of the tested sera the true status (sero-converted or not for non-structural proteins, i.e. presence of antibodies) of the animals was unknown, a Bayesian analysis employing a latent class model was used that did not rely on the use of a reference test or gold standard. Prior information about prevalence for subsets of the data and specificity of the tests was incorporated into the analysis. The specificity of the six tests for vaccinated and non-vaccinated cattle ranged from 96 to 99%. For vaccinated cattle, one test stood out with an estimated sensitivity of 94% (95% CI from 89.8 to 98.1%). Second best for vaccinated cattle were two tests with estimated sensitivities of 85% (95% CI from 78.9 to 89.7%) and 92% (95% CI from 86.2 to 95.6%). For non-vaccinated cattle, the sensitivities of these three tests were around 97%. The remaining three tests showed lower estimated sensitivity for vaccinated cattle, ranging from 57 to 79%.  相似文献   

17.
Epidemiologic issues in the validation of veterinary diagnostic tests   总被引：1，自引：0，他引：1  
In this review, we critically discuss the objectives, methods and limitations of different approaches for the validation of diagnostic tests. We show (based on published data and our own experiences) that estimates for the diagnostic sensitivity and specificity may vary among populations and/or subpopulations of animals, conditional on the distribution of influential covariates. Additional variability in those parameter estimates may be attributable to the sampling strategy. The uncertainty about diagnostic parameters is of concern for the decision-maker in the context of clinical diagnosis or quantitative risk assessment as well as for the epidemiologist who uses test data for prevalence estimation or risk-factor studies. Examples for the calculation of diagnostic parameters are presented together with bias-avoidance strategies. We suggest guidelines for an epidemiologic approach to test validation of veterinary diagnostic tests.  相似文献   

18.
Lyme disease is a zoonotic, vector-borne disease and occurs in mammals including horses. The disease is induced by infection with spirochetes of the Borrelia burgdorferi sensu lato group. Infection of mammalian hosts requires transmission of spirochetes by infected ticks during tick bites. Lyme disease diagnosis is based on clinical signs, possible exposure to infected ticks, and antibody testing which is traditionally performed by ELISA and Western blotting (WB). This report describes the development and validation of a new fluorescent bead-based multiplex assay for the detection of antibodies to B. burgdorferi outer surface protein A (OspA), OspC and OspF antigens in horse serum. Testing of 562 equine sera was performed blindly and in parallel by using WB and the new multiplex assay. Because a true gold standard is missing for Lyme antibody testing, we performed and compared different statistical approaches to validate the new Lyme multiplex assay. One approach was to use WB results as a 'relative gold standard' in ROC-curve and likelihood-ratio analyses of the new test. Cut-off values and interpretation ranges of the multiplex assay were established by the analysis. The second statistical approach used a Bayesian model for the calculation of diagnostic sensitivities and specificities of the multiplex assay. The Bayesian analysis takes into consideration that no true gold standard exists for detecting antibodies to B. burgdorferi and estimated sensitivities and specificities of both tests that were compared. Therefore, the Bayesian analysis also resulted in an evaluation of diagnostic sensitivity and specificity of WB. Overall, the new assay was characterized by low background values and a wide dynamic quantification range for the detection of antibodies to OspA, OspC and OspF antigens of B. burgdorferi. The diagnostic sensitivity and specificity for the OspA bead-based assay were calculated as 49% and 85%, respectively, and by a standard ROC curve analysis only because the Bayesian model could not be run on this parameter. The Bayesian-derived diagnostic sensitivities of the OspC and OspF assays were 80% and 86%, respectively. For comparison, the Bayesian-derived estimates for WB resulted in sensitivities of 72% for OspC and 80% for OspF. The Bayesian diagnostic specificities of the multiplex assay were 79% and 69% for OspC and OspF, respectively. WB analysis had specificities of 92% for OspC and 77% for OspF. Although the analysis of a new assay in the absence of a true gold standard remains challenging, the approach used here can help to address this problem when new technologies and traditionally used test standards differ significantly in their analytical sensitivities, which consequently causes problems in the calculation of diagnostic sensitivity and sensitivity values for the new assay. In summary, the new multiplex assay for the detection of antibodies to B. burgdorferi OspA, OspC and OspF antigens in horse serum has improved analytical and diagnostic sensitivities compared to WB analysis. Multiplex analysis is a valuable quantitative tool that simultaneously detects antibodies indicative for natural infection with and/or vaccination against the Lyme pathogen.  相似文献   

19.
There is a need for simple and inexpensive diagnostic and screening tests for the detection of Cryptosporidium parvum infection in calves. A sucrose wet mount test and a lateral immunochromatography test were evaluated for epidemiological sensitivity and specificity, cost per test, simplicity, test time and ease of batching. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the Cryptosporidium oocyst wall protein (COWP) gene locus, with gel electrophoresis, was used as a gold standard. Cohen's kappa statistic of agreement (kappa) between the Ontario Veterinary College (OVC) sucrose wet mount test and COWP PCR-RFLP was 0.82, and the sensitivity and specificity of the OVC sucrose wet mount test were 88.6% and 93.8%, respectively. The sensitivity and specificity of the lateral immunochromatography test were 78.3% and 93.3%, respectively, and agreement between this test and PCR-RFLP was good (kappa=0.73). There was substantial agreement between the OVC sucrose wet mount test and the lateral immunochromatography test (kappa=0.84). Both tests were inexpensive and easy to use; however, the lateral immunochromatography test was faster and simpler to perform than the sucrose wet mount test, and was generally more user-friendly. These tests provide practitioners and researchers with cheap, quick and accurate methods of detecting C. parvum infection in young calves.  相似文献   

20.
A retrospective study of various diagnostic postmortem techniques used in a 4-year surveillance program for detection of Mycobacterium bovis infection in wild white-tailed deer (Odocoileus virginianus) was conducted. The tests evaluated were routine histopathology, acid-fast staining, detection of acid-fast bacilli in culture, and an M. tuberculosis group-specific genetic probe applied to pure cultures. Each of these techniques were compared with a reference or "gold standard" of mycobacterial culture and identification. Histopathology, the most rapid form of testing for M. bovis infection in white-tailed deer samples, had a sensitivity of 98% and a specificity of 87%, resulting in a positive predictive value of 94%. The detection of acid-fast bacilli by staining was less sensitive than histopathology (90%), but its higher specificity (97%) resulted in a positive predictive value of 99%. The detection of acid-fast bacilli on culture was both highly specific (93%) and sensitive (100%). The group-specific genetic probe had the highest sensitivity and specificity and produced results in complete agreement with those of mycobacterial culture, suggesting that this technique could be used as the new "gold standard" for this particular wildlife tuberculosis surveillance program.  相似文献   

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