Improving the biomarker diagnostic capacity via functional transformations

The use of the area under the receiver-operating characteristic, ROC, curve (AUC) as an index of diagnostic accuracy is overwhelming in fields such as biomedical science and machine learning. It seems that a larger AUC value has become synonymous with a better performance. The functional transformation of the marker values has been proposed in the specialized literature as a procedure for increasing the AUC and therefore the diagnostic accuracy. However, the classification process is based on some regions (classification subsets) which support the decision made; one subject is classified as positive if its marker is within this region and classified as negative otherwise. In this paper we study the capacity of improving the classification performance of univariate biomarkers via functional transformations and the impact of this transformation on the final classification regions based on a real-world dataset. Particularly, we consider the problem of determining the gender of a subject based on the Mode frequency of his/her voice. The shape of the cumulative distribution function of this characteristic in both the male and the female groups makes the resulting classification problem useful for illustrating the differences between having useful diagnostic rules and obtaining an optimal AUC value. Our point is that improving the AUC by means of a functional transformation can produce classification regions with no practical interpretability. We propose to improve the classification accuracy by making the selection of the classification subsets more flexible while preserving their interpretability. Besides, we provide different graphical approximations which allow us a better understanding of the classification problem.     

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.     

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.     

Exact Bootstrap Variances of the Area Under ROC Curve

The area under the Receiver Operating Characteristic (ROC) curve (AUC) and related summary indices are widely used for assessment of accuracy of an individual and comparison of performances of several diagnostic systems in many areas including studies of human perception, decision making, and the regulatory approval process for new diagnostic technologies. Many investigators have suggested implementing the bootstrap approach to estimate variability of AUC-based indices. Corresponding bootstrap quantities are typically estimated by sampling a bootstrap distribution. Such a process, frequently termed Monte Carlo bootstrap, is often computationally burdensome and imposes an additional sampling error on the resulting estimates. In this article, we demonstrate that the exact or ideal (sampling error free) bootstrap variances of the nonparametric estimator of AUC can be computed directly, i.e., avoiding resampling of the original data, and we develop easy-to-use formulas to compute them. We derive the formulas for the variances of the AUC corresponding to a single given or random reader, and to the average over several given or randomly selected readers. The derived formulas provide an algorithm for computing the ideal bootstrap variances exactly and hence improve many bootstrap methods proposed earlier for analyzing AUCs by eliminating the sampling error and sometimes burdensome computations associated with a Monte Carlo (MC) approximation. In addition, the availability of closed-form solutions provides the potential for an analytical assessment of the properties of bootstrap variance estimators. Applications of the proposed method are shown on two experimentally ascertained datasets that illustrate settings commonly encountered in diagnostic imaging. In the context of the two examples we also demonstrate the magnitude of the effect of the sampling error of the MC estimators on the resulting inferences.     

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.     

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.     

Sensitivity,specificity and ROC-curves in multiple reader diagnostic trials—A unified,nonparametric approach

In diagnostic trials, the performance of a product is most frequently measured in terms such as sensitivity, specificity and the area under the ROC-curve (AUC). In multiple-reader trials, correlated data appear in a natural way since the same patient is observed under different conditions by several readers. The repeated measures may have quite an involved correlation structure. Even though sensitivity, specificity and the AUC are all assessments of diagnostic ability, a unified approach to analyze all such measurements allowing for an arbitrary correlation structure does not exist. Thus, a unified approach for these three effect measures of diagnostic ability will be presented in this paper. The fact that sensitivity and specificity are particular AUCs will serve as a basis for our method of analysis. As the presented theory can also be used in set-ups with correlated binomial random-variables, it may have a more extensive application than only in diagnostic trials.     

IRUSRT: A Novel Imbalanced Learning Technique by Combining Inverse Random Under Sampling and Random Tree

In this article, a novel technique IRUSRT (inverse random under sampling and random tree) by combining inverse random under sampling and random tree is proposed to implement imbalanced learning. The main idea is to severely under sample the majority class thus creating multiple distinct training sets. With each training set, a random tree is trained to separate the minority class from the majority class. By combining these random trees through fusion, a composite classifier is constructed. The experimental analysis on 23 real-world datasets assessed over area under the ROC curve (AUC), F-measure, and G-mean indicates that IRUSRT performs significantly better when compared with many existing class imbalance learning methods.     

The diagnostic accuracy of a composite index increases as the number of partitions of the components increases and when specific weights are assigned to each component

The aim of this work was to evaluate whether the number of partitions of index components and the use of specific weights for each component influence the diagnostic accuracy of a composite index. Simulation studies were conducted in order to compare the sensitivity, specificity and area under the ROC curve (AUC) of indices constructed using equal number of components but different number of partitions for all components. Moreover, the odds ratio obtained from the univariate logistic regression model for each component was proposed as potential weight. The current simulation results showed that the sensitivity, specificity and AUC of an index increase as the number of partitions of components increases. However, the rate that the diagnostic accuracy increases is reduced as the number of partitions increases. In addition, it was found that the diagnostic accuracy of the weighted index developed using the proposed weights is higher compared with that of the corresponding un-weighted index. The use of large-scale index components and the use of effect size measures (i.e. odds ratios, ORs) of index components as potential weights are proposed in order to obtain indices with high diagnostic accuracy for a particular binary outcome.     

Non‐parametric interval estimation for the partial area under the ROC curve

Accurate diagnosis of disease is a critical part of health care. New diagnostic and screening tests must be evaluated based on their abilities to discriminate diseased conditions from non‐diseased conditions. For a continuous‐scale diagnostic test, a popular summary index of the receiver operating characteristic (ROC) curve is the area under the curve (AUC). However, when our focus is on a certain region of false positive rates, we often use the partial AUC instead. In this paper we have derived the asymptotic normal distribution for the non‐parametric estimator of the partial AUC with an explicit variance formula. The empirical likelihood (EL) ratio for the partial AUC is defined and it is shown that its limiting distribution is a scaled chi‐square distribution. Hybrid bootstrap and EL confidence intervals for the partial AUC are proposed by using the newly developed EL theory. We also conduct extensive simulation studies to compare the relative performance of the proposed intervals and existing intervals for the partial AUC. A real example is used to illustrate the application of the recommended intervals. The Canadian Journal of Statistics 39: 17–33; 2011 © 2011 Statistical Society of Canada     

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.     

Point Estimates of Test Sensitivity and Specificity from Sample Means and Variances

In a wide variety of biomedical and clinical research studies, sample statistics from diagnostic marker measurements are presented as a means of distinguishing between two populations, such as with and without disease. Intuitively, a larger difference between the mean values of a marker for the two populations, and a smaller spread of values within each population, should lead to more reliable classification rules based on this marker. We formalize this intuitive notion by deriving practical, new, closed-form expressions for the sensitivity and specificity of three different discriminant tests defined in terms of the sample means and standard deviations of diagnostic marker measurements. The three discriminant tests evaluated are based, respectively, on the Euclidean distance and the Mahalanobis distance between means, and a likelihood ratio analysis. Expressions for the effects of measurement error are also presented. Our final expressions assume that the diagnostic markers follow independent normal distributions for the two populations, although it will be clear that other known distributions may be similarly analyzed. We then discuss applications drawn from the medical literature, although the formalism is clearly not restricted to that application.     

Confidence intervals for ratios of AUCs in the case of serial sampling: a comparison of seven methods

Pharmacokinetic studies are commonly performed using the two-stage approach. The first stage involves estimation of pharmacokinetic parameters such as the area under the concentration versus time curve (AUC) for each analysis subject separately, and the second stage uses the individual parameter estimates for statistical inference. This two-stage approach is not applicable in sparse sampling situations where only one sample is available per analysis subject similar to that in non-clinical in vivo studies. In a serial sampling design, only one sample is taken from each analysis subject. A simulation study was carried out to assess coverage, power and type I error of seven methods to construct two-sided 90% confidence intervals for ratios of two AUCs assessed in a serial sampling design, which can be used to assess bioequivalence in this parameter.     

Between a ROC and a hard place: Teaching prevalence plots to understand real world biomarker performance in the clinic

The Receiver Operating Characteristic (ROC) curve and the Area Under the Curve (AUC) of the ROC curve are widely used in discovery to compare the performance of diagnostic and prognostic assays. The ROC curve has the advantage that it is independent of disease prevalence. However, in this note, we remind scientists and clinicians that the performance of an assay upon translation to the clinic is critically dependent upon that very same prevalence. Without an understanding of prevalence in the test population, even robust bioassays with excellent ROC characteristics may perform poorly in the clinic. While the exact prevalence in the target population is not always known, simple plots of candidate assay performance as a function of prevalence rate give a better understanding of the likely real‐world performance and a greater understanding of the likely impact of variation in that prevalence on translation to the clinic.     

Statistical considerations in bioequivalence of two area under the concentration–time curves obtained from serial sampling data

In this paper, we study the bioequivalence (BE) inference problem motivated by pharmacokinetic data that were collected using the serial sampling technique. In serial sampling designs, subjects are independently assigned to one of the two drugs; each subject can be sampled only once, and data are collected at K distinct timepoints from multiple subjects. We consider design and hypothesis testing for the parameter of interest: the area under the concentration–time curve (AUC). Decision rules in demonstrating BE were established using an equivalence test for either the ratio or logarithmic difference of two AUCs. The proposed t-test can deal with cases where two AUCs have unequal variances. To control for the type I error rate, the involved degrees-of-freedom were adjusted using Satterthwaite's approximation. A power formula was derived to allow the determination of necessary sample sizes. Simulation results show that, when the two AUCs have unequal variances, the type I error rate is better controlled by the proposed method compared with a method that only handles equal variances. We also propose an unequal subject allocation method that improves the power relative to that of the equal and symmetric allocation. The methods are illustrated using practical examples.     

Nonparametric covariate adjustment for receiver operating characteristic curves

The accuracy of a diagnostic test is typically characterized using the receiver operating characteristic (ROC) curve. Summarizing indexes such as the area under the ROC curve (AUC) are used to compare different tests as well as to measure the difference between two populations. Often additional information is available on some of the covariates which are known to influence the accuracy of such measures. The authors propose nonparametric methods for covariate adjustment of the AUC. Models with normal errors and possibly non‐normal errors are discussed and analyzed separately. Nonparametric regression is used for estimating mean and variance functions in both scenarios. In the model that relaxes the assumption of normality, the authors propose a covariate‐adjusted Mann–Whitney estimator for AUC estimation which effectively uses available data to construct working samples at any covariate value of interest and is computationally efficient for implementation. This provides a generalization of the Mann–Whitney approach for comparing two populations by taking covariate effects into account. The authors derive asymptotic properties for the AUC estimators in both settings, including asymptotic normality, optimal strong uniform convergence rates and mean squared error (MSE) consistency. The MSE of the AUC estimators was also assessed in smaller samples by simulation. Data from an agricultural study were used to illustrate the methods of analysis. The Canadian Journal of Statistics 38:27–46; 2010 © 2009 Statistical Society of Canada     

Estimation methods for time‐dependent AUC models with survival data

The performance of clinical tests for disease screening is often evaluated using the area under the receiver‐operating characteristic (ROC) curve (AUC). Recent developments have extended the traditional setting to the AUC with binary time‐varying failure status. Without considering covariates, our first theme is to propose a simple and easily computed nonparametric estimator for the time‐dependent AUC. Moreover, we use generalized linear models with time‐varying coefficients to characterize the time‐dependent AUC as a function of covariate values. The corresponding estimation procedures are proposed to estimate the parameter functions of interest. The derived limiting Gaussian processes and the estimated asymptotic variances enable us to construct the approximated confidence regions for the AUCs. The finite sample properties of our proposed estimators and inference procedures are examined through extensive simulations. An analysis of the AIDS Clinical Trials Group (ACTG) 175 data is further presented to show the applicability of the proposed methods. The Canadian Journal of Statistics 38:8–26; 2010 © 2009 Statistical Society of Canada     

Area under the ROC curve comparison in the presence of missing data

The area under the receiver operating characteristic (ROC) curve (AUC) is broadly accepted and often used as a diagnostic accuracy index. Moreover, the equality among the predictive capacity of two or more diagnostic systems is frequently checked from the comparison of their respective AUCs. In paired designs, this comparison is usually performed by using only the subjects who have collected all the necessary information, in the so-called available-case analysis. On the other hand, the presence of missing data is a frequent problem, especially in retrospective and observational studies. The loss of statistical power and the misuse of the available information (with the resulting ethical implications) are the main consequences. In this paper a non-parametric method is developed to exploit all available information. In order to approximate the distribution for the proposed statistic, the asymptotic distribution is computed and two different resampling plans are studied. In addition, the methodology is applied to a real-world medical problem. Finally, some technical issues are also reported in the Appendix.     

ROC curve estimation based on local smoothing

ROC curve is a graphical representation of the relationship between sensitivity and specificity of a diagnostic test. It is a popular tool for evaluating and comparing different diagnostic tests in medical sciences. In the literature,the ROC curve is often estimated empirically based on an empirical distribution function estimator and an empirical quantile function estimator. In this paper an alternative nonparametric procedure to estimate the ROC Curve is suggested which is based on local smoothing techniques. Several numerical examples are presented to evaluate the performance of this procedure.     

Comparing Performance of Multiclass Classification Systems with ROC Manifolds: When Volume and Correct Classification Fails

Higher dimensional surfaces are used to examine the diagnostic performance of multiclass classification systems. These surfaces are extensions of the ROC curve and are known as ROC surfaces or manifolds. Manifolds may be constructed from either the correct classifications or from the misclassifications of the diagnostic system. Comparisons of the usefulness of each of these ROC manifolds with respect to the performance of the diagnostic system are made with emphasis on inferences from volume under the surface and optimal operating points (thresholds) of the system. Recommendations for when to use each type of ROC manifold and performance measure are discussed.