New methods give better estimates of changes in diagnostic accuracy when prior information is provided.
OBJECTIVE
Whether tests such as imaging should be read with or without access to prior clinical information is controversial. Naïve comparisons may suggest that the provision of prior information improves test accuracy, whereas in fact the opposite may be true. This is because provision of clinical background may actually bias test readers to over- or underinterpret relevant test findings, and they may suboptimally integrate the previous and current evidence. We propose comparing the combined accuracy of prior information and a test read (i) with or (ii) without knowledge of prior information. Analysis methods include simple decision rules and logistic regression.


METHODS
A study of cancer detection in women presenting with breast symptoms, in whom ultrasound could be read with or without reviewing prior mammography.


RESULTS
Naïve analysis gave an area under the receiver operating characteristics curve (AUC) for ultrasound read with mammography on view that was 4.6% higher (P < .01) than without mammography on view. Our approach, comparing the combined accuracy of mammography and ultrasound read i) with and ii) without knowledge of mammographic findings, showed much smaller differences.


CONCLUSIONS
Our approach is more appropriate than naïve analyses. The particular choice of analytic method depends on the study size and the diagnostic accuracy of combinations of the prior information and the test reading.
Screening and Test Evaluation Program, School of Public Health, Building A 27, University of Sydney, New South Wales 2006, Australia. lesi@health.usyd.edu.au
Les
L
Irwig
Petra
P
Macaskill
Stephen D
SD
Walter
Nehmat
N
Houssami
D000328:Adult; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary