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Environ Health Perspect. 1994 November; 102(Suppl 8): 73–78.
PMCID: PMC1566538
Research Article

ROC curve regression analysis: the use of ordinal regression models for diagnostic test assessment.


Diagnostic tests commonly are characterized by their true positive (sensitivity) and true negative (specificity) classification rates, which rely on a single decision threshold to classify a test result as positive. A more complete description of test accuracy is given by the receiver operating characteristic (ROC) curve, a graph of the false positive and true positive rates obtained as the decision threshold is varied. A generalized regression methodology, which uses a class of ordinal regression models to estimate smoothed ROC curves has been described. Data from a multi-institutional study comparing the accuracy of magnetic resonance (MR) imaging with computed tomography (CT) in detecting liver metastases, which are ideally suited for ROC regression analysis, are described. The general regression model is introduced and an estimate for the area under the ROC curve and its standard error using parameters of the ordinal regression model is given. An analysis of the liver data that highlights the utility of the methodology in parsimoniously adjusting comparisons for covariates is presented.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Metz CE. ROC methodology in radiologic imaging. Invest Radiol. 1986 Sep;21(9):720–733. [PubMed]
  • Tosteson AN, Begg CB. A general regression methodology for ROC curve estimation. Med Decis Making. 1988 Jul-Sep;8(3):204–215. [PubMed]
  • Begg CB. Biases in the assessment of diagnostic tests. Stat Med. 1987 Jun;6(4):411–423. [PubMed]
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  • Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. [PubMed]
  • Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983 Sep;148(3):839–843. [PubMed]
  • Swets JA. Indices of discrimination or diagnostic accuracy: their ROCs and implied models. Psychol Bull. 1986 Jan;99(1):100–117. [PubMed]

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