Comparison of correlated receiver operating characteristic curves derived from repeated diagnostic test data.

RATIONAL AND OBJECTIVES It is common to administer the same diagnostic test more than once to the same set of patients. The purpose of this study was to develop two statistical methods for estimating and comparing correlated receiver operating characteristic (ROC) curves for data derived from repeated diagnostic tests. MATERIAL AND METHODS Parametric and semiparametric transformation models were developed. These estimation methods were illustrated with data from 72 pigmented lesions suspected of being malignant melanoma. A diagnostic scoring system based on asymmetry, border irregularity, color variation, and diameter was used repeatedly, with or without a dermoscope. Statistical hypothesis tests were conducted to evaluate whether a dermoscope improved the clarity of the lesion features in the scoring system. The resulting ROC curves were constructed, along with characteristics and summary measures. RESULTS The areas under the ROC curves were 0.885 (parametric method) and 0.893 (semiparametric method) without the dermoscope, and 0.916 (parametric) and 0.912 (semiparametric) with the dermoscope. The statistical hypothesis tests did not yield statistically significant differences between the underlying ROC curves for either estimation method. CONCLUSION The two transformation models yielded similar results for estimation and comparison of the ROC curves. Although a dermoscope did not add extra information, the scoring system was accurate for diagnosing malignant melanoma.