Med Decis Making - Estimating the relative utility of screening mammography.

Tópicos

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Resumo

CKGROUND: The concept of diagnostic utility is a fundamental component of signal detection theory, going back to some of its earliest works. Attaching utility values to the various possible outcomes of a diagnostic test should, in principle, lead to meaningful approaches to evaluating and comparing such systems. However, in many areas of medical imaging, utility is not used because it is presumed to be unknown.METHODS: In this work, we estimate relative utility (the utility benefit of a detection relative to that of a correct rejection) for screening mammography using its known relation to the slope of a receiver operating characteristic (ROC) curve at the optimal operating point. The approach assumes that the clinical operating point is optimal for the goal of maximizing expected utility and therefore the slope at this point implies a value of relative utility for the diagnostic task, for known disease prevalence. We examine utility estimation in the context of screening mammography using the Digital Mammographic Imaging Screening Trials (DMIST) data.RESULTS: We show how various conditions can influence the estimated relative utility, including characteristics of the rating scale, verification time, probability model, and scope of the ROC curve fit. Relative utility estimates range from 66 to 227.CONCLUSIONS: We argue for one particular set of conditions that results in a relative utility estimate of 162 (?14%). This is broadly consistent with values in screening mammography determined previously by other means. At the disease prevalence found in the DMIST study (0.59% at 365-day verification), optimal ROC slopes are near unity, suggesting that utility-based assessments of screening mammography will be similar to those found using Youden's index.

Resumo Limpo

ckground concept diagnost util fundament compon signal detect theori go back earliest work attach util valu various possibl outcom diagnost test principl lead meaning approach evalu compar system howev mani area medic imag util use presum unknownmethod work estim relat util util benefit detect relat correct reject screen mammographi use known relat slope receiv oper characterist roc curv optim oper point approach assum clinic oper point optim goal maxim expect util therefor slope point impli valu relat util diagnost task known diseas preval examin util estim context screen mammographi use digit mammograph imag screen trial dmist dataresult show various condit can influenc estim relat util includ characterist rate scale verif time probabl model scope roc curv fit relat util estim rang conclus argu one particular set condit result relat util estim broad consist valu screen mammographi determin previous mean diseas preval found dmist studi day verif optim roc slope near uniti suggest utilitybas assess screen mammographi will similar found use youden index

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