LECTURE 9 PRACTICE Sensitivity, Specificity, NPV,

QUESTIONS PPV and ROC

A new test has been developed to screen for ovarian cancer. The following figure
illustrates the distribution of values for this test among two populations

If the researcher chooses values under 30 μg/dL as normal limits for the test, which of the
following statements is true?
A. The test will be 100% specific
B. The test will be 100% sensitive
C. Some persons without cancer will test positive
D. There will be some false-positive tests
E. All persons with cancer will have a positive test
Four new Hepatitis B specific serologies are developed by different research
laboratories. The test performance characteristics are used to create the receiver
operator curve (ROC) illustrated in the following figure.

Which of the five tests would be best to use as a diagnostic tool?

Dr. Vera Blues, a noted psychiatric epidemiologist, is interested in the diagnosis of
depression. She develops a new test for its diagnosis, which she calls the Blues test.
According to the gold standard, which involves meeting the DSM-IV criteria, about
10% of adults in the United States are depressed. Dr. Blues applies her new test to
100 persons diagnosed as being depressed by the gold standard; 80 have a positive
Blues test. She finds 400 persons who are not depressed; 60 have a positive test.
She reports her findings in the Journal of the Society of Academic Psychiatrists
(JSAP).
Depressed Not Depressed

Positive Blues test

Negative Blues test

Total

Calculate Sensitivity and Specificity of the test.

A new test for chlamydial infections of the cervix is introduced.
Half of the women who are tested have a positive test.
Compared with the gold standard of careful cultures, 45% of
those with a positive test are infected with chlamydia, and 95%
of those with a negative test are free of the infection.

a. What is the sensitivity of the test?

25% b. What is the false positive rate (FPR) of
the test?
45%
0.37
63%
63%
90%
37%
95%
95%
Since the number of women who were tested was not provided a number can
be assumed (for ease of calculation 400 was selected for completing the 2x2
table.
half have a positive test: 200
 45% of those who tested positive have the infection (chlamydia): 90

95% of those with a negative test are free of the disease: 190

Infection No Infection Tota

l
Test Positive 90 110 200
Test Negative 10 190 200
Total 100 300 400
A physical examination was used to screen for breast Cancer in 2500 women with
biopsy proven adenocarcinoma of the breast and in 5000 age and race matched
control women. The results of the physical examination were positive (i.e. a mass
was palpated) in 1800 cases and 800 control women (who showed no evidence of
cancer at biopsy). Calculate the following:
a) Specificity
b) Proportion of false positive test (FPR)
c) Proportion false negative test (FNR)
d) Accuracy
e) NPV
Specificity = (4200/5000) x100
 =84%

Proportion of false positive/ FPR= 100-specificity = 100-84

 =16% or 0.16

Proportion of false negative= 100-sensitivity = 100-72

 =28% or 0.28

Accuracy = (1800 + 4200) / 7500 = 80%

NPV = (700/4900) x100

 =85.71%
A colon Cancer screening study is being conducted in a town. Individuals aged 50 to
75 years will be screened with the hemoccult test, a stool sample is tested for the
presence of blood (RBCs under microscope). The hemoccult test has a sensitivity of
70% and a specificity of 75%. If the prevalence of ca colon in the population of 50-
75 years of age in this town is 2/1000. What is the PPV for this test? Use a
hypothetical sample of 5000.
Prevalence = Total diseased / Total sample examined = 2/1000 = 0.002
Sensitivity = T+/total diseased = 0.70
Specificity = T- / total disease free = 0.75.

0.002 = Total diseased / 5000

Total diseased = 5000 x 0.002 = 10

0.70 = T+/10
T+ = 0.70 x 10=7
0.75 = T- / (5000-10)
T- = 0.75 x 4990 = 3743

Answer:
PPV= 7/1254 x 100
= 0.6%
A screening test using a new serum marker is developed for diagnosing ovarian cancer.

Compared to the blue curves, the red curves are associated with
a) Higher sensitivity and lower specificity
b) Higher sensitivity and same specificity
c) Lower sensitivity and higher specificity
d) Higher sensitivity and higher specificity
e) Lower sensitivity and lower
A new real time-PCR test for the hepatitis C virus is approved for medical use. The
manufacturer sets the threshold number of DNA copies required to achieve a positive
result such that the sensitivity is 98% and the specificity is 80%. The tested population
has a hepatitis C prevalence of 0.7%. Which of the following changes in the prevalence,
incidence, or threshold concentration will increase the positive predictive value of the
test, if the other two values are held constant?

a) An increase in incidence
b) An increase in prevalence
c) A decrease in incidence
d) A decrease in prevalence
e) Lowering the threshold concentration required for a positive test