The average area under correlated receiver operating characteristic curves: a nonparametric approach based on generalized two-sample Wilcoxon statistics

It is well known that, when sample observations are independent, the area under the receiver operating characteristic (ROC) curve corresponds to the Wilcoxon statistics if the area is calculated by the trapezoidal rule. Correlated ROC curves arise often in medical research and have been studied by various parametric methods. On the basis of the Mann–Whitney U-statistics for clustered data proposed by Rosner and Grove, we construct an average ROC curve and derive nonparametric methods to estimate the area under the average curve for correlated ROC curves obtained from multiple readers. For the more complicated case where, in addition to multiple readers examining results on the same set of individuals, two or more diagnostic tests are involved, we derive analytic methods to compare the areas under correlated average ROC curves for these diagnostic tests. We demonstrate our methods in an example and compare our results with those obtained by other methods. The nonparametric average ROC curve and the analytic methods that we propose are easy to explain and simple to implement.     

An alternative method for global and partial comparison of two diagnostic systems based on ROC curves

In this paper, an alternative method for the comparison of two diagnostic systems based on receiver operating characteristic (ROC) curves is presented. ROC curve analysis is often used as a statistical tool for the evaluation of diagnostic systems. However, in general, the comparison of ROC curves is not straightforward, in particular, when they cross each other. A similar difficulty is also observed in the multi-objective optimization field where sets of solutions defining fronts must be compared with a multi-dimensional space. Thus, the proposed methodology is based on a procedure used to compare the performance of distinct multi-objective optimization algorithms. In general, methods based on the area under the ROC curves are not sensitive to the existence of crossing points between the curves. The new approach can deal with this situation and also allows the comparison of partial portions of ROC curves according to particular values of sensitivity and specificity of practical interest. Simulations results are presented. For illustration purposes, considering real data from newborns with very low birthweight, the new method was applied in order to discriminate the better index for evaluating the risk of death.     

An application of lomax distributions in receiver operating characteristic(roc)curve analysis

Receiver operating characteristic(ROC)curves are useful for studying the performance of diagnostic tests. ROC curves occur in many fields of applications including psychophysics, quality control and medical diagnostics. In practical situations, often the responses to a diagnostic test are classified into a number of ordered categories. Such data are referred to as ratings data. It is typically assumed that the underlying model is based on a continuous probability distribution. The ROC curve is then constructed from such data using this probability model. Properties of the ROC curve are inherited from the model. Therefore, understanding the role of different probability distributions in ROC modeling is an interesting and important area of research. In this paper the Lomax distribution is considered as a model for ratings data and the corresponding ROC curve is derived. The maximum likelihood estimation procedure for the related parameters is discussed. This procedure is then illustrated in the analysis of a neurological data example.     

Compare diagnostic tests using transformation-invariant smoothed ROC curves()

Receiver operating characteristic (ROC) curve, plotting true positive rates against false positive rates as threshold varies, is an important tool for evaluating biomarkers in diagnostic medicine studies. By definition, ROC curve is monotone increasing from 0 to 1 and is invariant to any monotone transformation of test results. And it is often a curve with certain level of smoothness when test results from the diseased and non-diseased subjects follow continuous distributions. Most existing ROC curve estimation methods do not guarantee all of these properties. One of the exceptions is Du and Tang (2009) which applies certain monotone spline regression procedure to empirical ROC estimates. However, their method does not consider the inherent correlations between empirical ROC estimates. This makes the derivation of the asymptotic properties very difficult. In this paper we propose a penalized weighted least square estimation method, which incorporates the covariance between empirical ROC estimates as a weight matrix. The resulting estimator satisfies all the aforementioned properties, and we show that it is also consistent. Then a resampling approach is used to extend our method for comparisons of two or more diagnostic tests. Our simulations show a significantly improved performance over the existing method, especially for steep ROC curves. We then apply the proposed method to a cancer diagnostic study that compares several newly developed diagnostic biomarkers to a traditional one.     

Fitting Roc Curves Using Non-linear Binomial Regression

The performance of a diagnostic test is summarized by its receiver operating characteristic (ROC) curve. Empirical data on a test's performance often come in the form of observed true positive and false positive relative frequencies, under varying conditions. This paper describes a family of models for analysing such data. The underlying ROC curves are specified by a shift parameter, a shape parameter and a link function. Both the position along the ROC curve and the shift parameter are modelled linearly. The shape parameter enters the model non-linearly but in a very simple manner. One simple application is to the meta-analysis of independent studies of the same diagnostic test, illustrated on some data of Moses, Shapiro & Littenberg (1993). A second application to so-called vigilance data is given, where ROC curves differ across subjects, and modelling of the position along the ROC curve is of primary interest.     

ROC analysis for multiple markers with tree-based classification

Multiple biomarkers are frequently observed or collected for detecting or understanding a disease. The research interest of this article is to extend tools of receiver operating characteristic (ROC) analysis from univariate marker setting to multivariate marker setting for evaluating predictive accuracy of biomarkers using a tree-based classification rule. Using an arbitrarily combined and-or classifier, an ROC function together with a weighted ROC function (WROC) and their conjugate counterparts are introduced for examining the performance of multivariate markers. Specific features of the ROC and WROC functions and other related statistics are discussed in comparison with those familiar properties for univariate marker. Nonparametric methods are developed for estimating the ROC and WROC functions, and area under curve and concordance probability. With emphasis on population average performance of markers, the proposed procedures and inferential results are useful for evaluating marker predictability based on multivariate marker measurements with different choices of markers, and for evaluating different and-or combinations in classifiers.     

Generalized Confidence Interval Estimation for the Difference in Paired Areas Under the ROC Curves in the Absence of a Gold Standard

Receiver operating characteristic (ROC) curves can be used to assess the accuracy of tests measured on ordinal or continuous scales. The most commonly used measure for the overall diagnostic accuracy of diagnostic tests is the area under the ROC curve (AUC). A gold standard (GS) test on the true disease status is required to estimate the AUC. However, a GS test may be too expensive or infeasible. In many medical researches, the true disease status of the subjects may remain unknown. Under the normality assumption on test results from each disease group of subjects, we propose a heuristic method of estimating confidence intervals for the difference in paired AUCs of two diagnostic tests in the absence of a GS reference. This heuristic method is a three-stage method by combining the expectation-maximization (EM) algorithm, bootstrap method, and an estimation based on asymptotic generalized pivotal quantities (GPQs) to construct generalized confidence intervals for the difference in paired AUCs in the absence of a GS. Simulation results show that the proposed interval estimation procedure yields satisfactory coverage probabilities and expected interval lengths. The numerical example using a published dataset illustrates the proposed method.     

A general class of hierarchical ordinal regression models with applications to correlated roc analysis

The authors discuss a general class of hierarchical ordinal regression models that includes both location and scale parameters, allows link functions to be selected adaptively as finite mixtures of normal cumulative distribution functions, and incorporates flexible correlation structures for the latent scale variables. Exploiting the well‐known correspondence between ordinal regression models and parametric ROC (Receiver Operating Characteristic) curves makes it possible to use a hierarchical ROC (HROC) analysis to study multilevel clustered data in diagnostic imaging studies. The authors present a Bayesian approach to model fitting using Markov chain Monte Carlo methods and discuss HROC applications to the analysis of data from two diagnostic radiology studies involving multiple interpreters.     

A test for crossing receiver operating characteristic (roc) curves

The receiver operating characteristic (ROC) curve gives a graphical representation of sensitivity and specificity of a prediction model when varying the decision treshold on a diagnostic criterion. A classical test for comparing the overall accuracies for two models -1 and 2- is based on the difference between ROC curves areas - related to its standard error. This test is designed for the situation where ROC curve 1 caps ROC curve 2. Often both curves cross :in this paper, a new test, based on the integrated difference between the curves, is proposed to deal with this situation. In a simulation experiment, the new test was less powerful than the old test for detecting an overall superiority, but much more powerfull against the crossing alternative.     

Nonparametric and semiparametric estimation of the three way receiver operating characteristic surface

In many situations the diagnostic decision is not limited to a binary choice. Binary statistical tools such as receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) need to be expanded to address three-category classification problem. Previous authors have suggest various ways to model the extension of AUC but not the ROC surface. Only simple parametric approaches are proposed for modeling the ROC measure under the assumption that test results all follow normal distributions. We study the estimation methods of three-dimensional ROC surfaces with nonparametric and semiparametric estimators. Asymptotical results are provided as a basis for statistical inference. Simulation studies are performed to assess the validity of our proposed methods in finite samples. We consider an Alzheimer's disease example from a clinical study in the US as an illustration. The nonparametric and semiparametric modelling approaches for the three way ROC analysis can be readily generalized to diagnostic problems with more than three classes.     

Applications of the Bootstrap in ROC Analysis

The problem of estimating standard errors for diagnostic accuracy measures might be challenging for many complicated models. We can address such a problem by using the Bootstrap methods to blunt its technical edge with resampled empirical distributions. We consider two cases where bootstrap methods can successfully improve our knowledge of the sampling variability of the diagnostic accuracy estimators. The first application is to make inference for the area under the ROC curve resulted from a functional logistic regression model which is a sophisticated modelling device to describe the relationship between a dichotomous response and multiple covariates. We consider using this regression method to model the predictive effects of multiple independent variables on the occurrence of a disease. The accuracy measures, such as the area under the ROC curve (AUC) are developed from the functional regression. Asymptotical results for the empirical estimators are provided to facilitate inferences. The second application is to test the difference of two weighted areas under the ROC curve (WAUC) from a paired two sample study. The correlation between the two WAUC complicates the asymptotic distribution of the test statistic. We then employ the bootstrap methods to gain satisfactory inference results. Simulations and examples are supplied in this article to confirm the merits of the bootstrap methods.     

A Framework for Random-Effects ROC Analysis: Biases with the Bootstrap and Other Variance Estimators

In this article, we analyze the three-way bootstrap estimate of the variance of the reader-averaged nonparametric area under the receiver operating characteristic (ROC) curve. The setting for this work is medical imaging, and the experimental design involves sampling from three distributions: a set of normal and diseased cases (patients), and a set of readers (doctors). The experiment we consider is fully crossed in that each reader reads each case. A reading generates a score that indicates the reader's level of suspicion that the patient is diseased. The distribution of scores for the normal patients is compared to the distribution of scores for the diseased patients via an ROC curve, and the area under the ROC curve (AUC) summarizes the reader's diagnostic ability to separate the normal patients from the diseased ones. We find that the bootstrap estimate of the variance of the reader-averaged AUC is biased, and we represent this bias in terms of moments of success outcomes. This representation helps unify and improve several current methods for multi-reader multi-case (MRMC) ROC analysis.     

Powerful nonparametric statistics to compare k independent ROC curves

The authors deal with the problem of comparing receiver operating characteristic (ROC) curves from independent samples. From a nonparametric approach, they propose and study three different statistics. Their asymptotic distributions are obtained and a resample plan is considered. In order to study the statistical power of the introduced statistics, a simulation study is carried out. The (observed) results suggest that, for the considered models, the new statistics are more powerful than the usually employed ones (the Venkatraman test and the usual area under the ROC curve criterion) in non-uniform dominance situations and quite good otherwise.     

A non-inferiority test for diagnostic accuracy in the absence of the golden standard test based on the paired partial areas under receiver operating characteristic curves

Non-inferiority tests are often measured for the diagnostic accuracy in medical research. The area under the receiver operating characteristic (ROC) curve is a familiar diagnostic measure for the overall diagnostic accuracy. Nevertheless, since it may not differentiate the diverse shapes of the ROC curves with different diagnostic significance, the partial area under the ROC (PAUROC) curve, another summary measure emerges for such diagnostic processes that require the false-positive rate to be in the clinically interested range. Traditionally, to estimate the PAUROC, the golden standard (GS) test on the true disease status is required. Nevertheless, the GS test may sometimes be infeasible. Besides, in a lot of research fields such as the epidemiology field, the true disease status of the patients may not be known or available. Under the normality assumption on diagnostic test results, based on the expectation-maximization algorithm in combination with the bootstrap method, we propose the heuristic method to construct a non-inferiority test for the difference in the paired PAUROCs without the GS test. Through the simulation study, although the proposed method might provide a liberal test, as a whole, the empirical size of the proposed method sufficiently controls the size at the significance level, and the empirical power of the proposed method in the absence of the GS is as good as that of the non-inferiority in the presence of the GS. The proposed method is illustrated with the published data.     

ROC curve and covariates: extending induced methodology to the non-parametric framework

Continuous diagnostic tests are often used to discriminate between diseased and healthy populations. The receiver operating characteristic (ROC) curve is a widely used tool that provides a graphical visualisation of the effectiveness of such tests. The potential performance of the tests in terms of distinguishing diseased from healthy people may be strongly influenced by covariates, and a variety of regression methods for adjusting ROC curves has been developed. Until now, these methodologies have assumed that covariate effects have parametric forms, but in this paper we extend the induced methodology by allowing for arbitrary non-parametric effects of a continuous covariate. To this end, local polynomial kernel smoothers are used in the estimation procedure. Our method allows for covariate effect not only on the mean, but also on the variance of the diagnostic test. We also present a bootstrap-based method for testing for a significant covariate effect on the ROC curve. To illustrate the method, endocrine data were analysed with the aim of assessing the performance of anthropometry for predicting clusters of cardiovascular risk factors in an adult population in Galicia (NW Spain), duly adjusted for age. The proposed methodology has proved useful for providing age-specific thresholds for anthropometric measures in the Galician community.     

Local linear smoothing of receiver operating characteristic (ROC) curves

For measuring the accuracy of a continuous diagnostic test, the receiver operating characteristic (ROC) curve is often used. The empirical ROC curve is the most commonly used non-parametric estimator for the ROC curve. Recently, Lloyd (J. Amer. Statist. Assoc. 93(1998) 1356) proposed a kernel smoothing estimator for the ROC curve and showed his estimator has better mean square error than the empirical ROC curve estimator. However, Lloyd's estimator involves two bandwidths and has a boundary problem. In addition, his choice of bandwidths is ad hoc. In this paper we propose another kernel smoothing estimator which involves only one bandwidth and does not have the boundary problem. Furthermore, our choice of the bandwidth is asymptotically optimal.     

Robustness of Approaches to ROC Curve Modeling under Misspecification of the Underlying Probability Model

A variety of statistical regression models have been proposed for the comparison of ROC curves for different markers across covariate groups. Pepe developed parametric models for the ROC curve that induce a semiparametric model for the market distributions to relax the strong assumptions in fully parametric models. We investigate the analysis of the power ROC curve using these ROC-GLM models compared to the parametric exponential model and the estimating equations derived from the usual partial likelihood methods in time-to-event analyses. In exploring the robustness to violations of distributional assumptions, we find that the ROC-GLM provides an extra measure of robustness.     

Detecting diagnostic accuracy of two biomarkers through a bivariate log-normal ROC curve

In biomedical research, two or more biomarkers may be available for diagnosis of a particular disease. Selecting one single biomarker which ideally discriminate a diseased group from a healthy group is confront in a diagnostic process. Frequently, most of the people use the accuracy measure, area under the receiver operating characteristic (ROC) curve to choose the best diagnostic marker among the available markers for diagnosis. Some authors have tried to combine the multiple markers by an optimal linear combination to increase the discriminatory power. In this paper, we propose an alternative method that combines two continuous biomarkers by direct bivariate modeling of the ROC curve under log-normality assumption. The proposed method is applied to simulated data set and prostate cancer diagnostic biomarker data set.     

Bayesian ROC curve estimation under binormality using an ordinal category likelihood

Receiver operating characteristic (ROC) curve has been widely used in medical diagnosis. Various methods are proposed to estimate ROC curve parameters under the binormal model. In this paper, we propose a Bayesian estimation method from the continuously distributed data which is constituted by the truth-state-runs in the rank-ordered data. By using an ordinal category data likelihood and following the Metropolis–Hastings (M–H) procedure, we compute the posterior distribution of the binormal parameters, as well as the group boundaries parameters. Simulation studies and real data analysis are conducted to evaluate our Bayesian estimation method.     

Consistency of non parametric estimators of the area under the ROC curve

ABSTRACT

The area under the receiver operating characteristic (ROC) curve is a popular summary index that measures the accuracy of a continuous-scale diagnostic test to measure its accuracy. Under certain conditions on estimators of distribution functions, we prove a theorem on strong consistency of the non parametric “plugin” estimators of the area under the ROC curve. Based on this theorem, we construct some new “plugin” consistent estimators. The performance of the non parametric estimators considered is illustrated numerically and the estimators are compared in terms of bias, variance, and mean square error.