Testing Equality between Two Diagnostic Procedures in Paired-Sample Ordinal Data


  • Kung-Jong Lui,

  • Xiao-Hua Zhou,

    1. Department of Biostatistics, University of Washington, F600 Health Sciences, Box 357232, Seattle, WA 98195, and HSR D Center of Excellence, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA
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  • Chii-Dean Lin

    1. Department of Mathematics and Statistics, San Diego State University, San Diego, CA 92182-7720, USA
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When a new diagnostic procedure is developed, it is important to assess whether the diagnostic accuracy of the new procedure is different from that of the standard procedure. For paired-sample ordinal data, this paper develops two test statistics for testing equality of the diagnostic accuracy between two procedures without assuming any parametric models. One is derived on the basis of the probability of correctly identifying the case for a randomly selected pair of a case and a non-case over all possible cutoff points, and the other is derived on the basis of the sensitivity and specificity directly. To illustrate the practical use of the proposed test procedures, this paper includes an example regarding the use of digitized and plain films for screening breast cancer. This paper also applies Monte Carlo simulation to evaluate the finite sample performance of the two statistics developed here and notes that they can perform well in a variety of situations. (© 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)