Evaluation of a screening

test
- NITIN S PATIL
Moderator - DR.GURURAJ N A
Evaluation of a screening test
Measures used to evaluate a screening test are:

1. Sensitivity

2. Specificity

3. Predictive value of a positive test

4. Predictive value of a negative test

5. False-negatives

6. False-positives
Basic definitions

True positive (a) - means those who have the disease and the test result is also
positive

False positive (b) - means those who do not have the disease but the test result is
positive

False negative (c) - means those who have the disease but the test result is
negative

True negative (d) - means those who do not have the disease and the test result is
also negative.
1. Sensitivity

Sensitivity - It is the ability of a test to correctly identify those having the

disease, i.e., TRUE POSITIVE

(i.e., percentage of diseased persons, showing the test Result positive)

2. Specificity
Specificity - It is the ability of the test to correctly identify those who are not
having the disease, i.e.,TRUE NEGATIVE

(i.e., percentage of non diseased persons, showing the test result negative )
 Diagnosis of brain tumours
by EEG

Sensitivity = 36/40 × 100 = 90 per cent

Specificity = 306,000/360,000 x 100 = 85 per
cent

Diagnosis of brain tumours by computer assisted

axial tomography

Sensitivity = 39/40 × 100 = 97.5 per cent

Specificity = 342,000/360,000 x 100 = 95 per
 Diagnosis of brain tumours by EEG

Sensitivity = 36/40 × 100 = 90 per cent

Specificity = 306,000/360,000 x 100 = 85 per cent

Diagnosis of brain tumours by computer assisted axial tomography

Sensitivity = 36/40 × 100 = 90 per cent

Specificity = 306,000/360,000 x 100 = 85 per cent
Sensitivity and specificity of a 2-hour postprandial blood test for glucose for 70 true
diabetics and 510 true non-diabetics at different levels of blood glucose
Predictive value

It means the diagnostic power of a test.

Two results - positive and negative

The predictive accuracy depends upon sensitivity, specificity and disease

prevalence
3.predictive value of a positive test

It means the probability of an individual really having the disease, if the test
result is positive.

(i.e., percentage of positives probably having the disease)

The more is the prevalence of a disease in a given population , the more

accurate will be the predictive value of a positive screening test.
4. Predictive value of a negative test

It means the probability of an individual really not having the disease, if the
test result is negative.

( i.e., percentage of negatives probably not having the disease)

5. False negatives

These are the percentage of diseased persons wrongly identified as not having
the disease, because the test result is negative.

The lower the sensitivity, the larger will be the the number of false negatives.
6. False positives

These are the percentage of non diseased persons wrongly identified as having
the disease, because the test result is positive.
 Screening test result by
diagnosis

(a) Sensitivity (true-positive) = (40/140) × 100= 28.57%

(b) Specificity (true-negative) = (9840/9860) × 100 = 99.79%
(c)False-negative = (100/140) × 100 = 71.4%
()False-positive = (20/9860) × 100= 0.20%
(e) Predictive value of a positive test = (40/60) × 100= 66.66%
(f) Predictive value of a negative test = (9840/9940) × 100 =
98.9%
 Methods of evaluation of screening programs

1. Randomised controlled trials ( RCT)

Ideally evaluation should be done by RCT.

One group (randomly selected) receives the screening test.

Control - which receives no such test.

Ideally RCT should be performed in settings where screening programme will be

implemented, and should employ same type of personnel, equipment and
procedures that will be used in that programme.
2. Uncontrolled trials

These trials are used to see if people with disease detected through screening
appear to live longer after diagnosis and treatment than patients who are not
screened.

Ex- uncontrolled studies of cervical cancer screening which indicated that

deaths from that disease could be very much reduced if every woman was
examined periodically.
3. Other methods

Other methods of evaluation include -

Case control studies

Comparison in trends between areas with different degrees of screening

coverage.
My references -

Park’s textbook of preventive and social medicine.

IAPSM

AH Suryakantha
Thank you