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A Philosophical Approach to Diagnostic Test Evaluation
- Gabe S. Sonke, MD, PhD;
- André L.M. Verbeek, MD, PhD; and
- Lambertus A.L.M. Kiemeney, PhD
- From the Netherlands Cancer Institute, Amsterdam, the Netherlands, and Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
TO THE EDITOR:
In their recent article, Lord and colleagues (1) propose a framework to decide when measuring diagnostic test accuracy is sufficient to evaluate a diagnostic test and when a randomized trial is needed. Their work, in accordance with most previous papers on the subject, considers accuracy and patient outcome studies as separate phases in the evaluation of a diagnostic test: Accuracy studies show how well a diagnostic test identifies the true presence or absence of disease, and patient outcome studies show whether a patient classification based on the new test better predicts patient outcome. We feel that this phased evaluation of diagnostic tests lacks appreciation of the fact …
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