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PubMed2001

Barium enema and endoscopy for the detection of colorectal neoplasia: sensitivity, specificity, complications and its determinants.

AIM: To analyse sensitivity, specificity and complication rate of endoscopy, and barium enema for the detection of colorectal neoplasia. MATERIALS AND METHODS: A MEDLINE search was performed (1980-2000) directed at the endoscopic and radiologic literature on barium enema. Articles were selected based on the type of study, availability of sensitivity and specificity values in sizeable patient groups, and reports on complications. Sixty articles were included in the analysis. RESULTS: Endoscopy proved to have superior sensitivity for polyps in patients at high-risk for colorectal neoplasia. The role of endoscopy and radiology in average-risk screening populations is not known. Sensitivity and specificity rates ranged widely, probably due to bias. For the detection of small polyps endoscopy has superior performance, whereas sensitivity is similar for endoscopy and barium enema for the detection of larger (>1 cm) polyps and tumours. Overall, endoscopy is associated with a higher complication rate. CONCLUSION: Endoscopy is the preferred detection method in high-risk patients. The role of endoscopy and radiology in a screening setting requires evaluation. This review provides the test characteristics of endoscopy and radiology which are relevant for a cost-effectiveness analysis. Double-contrast barium enema may play an important role for screening purposes, owing to its good sensitivity for detecting larger (>1 cm) polyps and its lack of major complications. de Zwart, I. M.et al. (2001). Clinical Radiology56, 401-409.

Barium Sulfate↗
PubMed2003

Sensitivity, specificity and accuracy of stress SPECT myocardial perfusion imaging for detection of coronary artery disease in the distribution of first-order branch vessels, using an anatomical matching of angiographic and perfusion data.

We sought to investigate the utility of stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the identification of coronary artery disease (CAD) in the distribution of first-order branch vessels. We evaluated 135 consecutive patients with coronary angiography and stress SPECT MPI. We anatomically matched angiography and SPECT to assess the sensitivity, specificity and accuracy of SPECT MPI for the detection of CAD in the distribution of first-order branches. Subgroup analysis for stress test performance and previous coronary artery bypass grafting (CABG) was also performed. The sensitivity, specificity and accuracy of stress SPECT MPI for the detection of CAD in the distribution of first-order branch vessels were all 67%. For isolated branch vessel CAD, stress SPECT MPI had a sensitivity of 44%. In patients without CABG, the sensitivity, specificity and accuracy for the detection of CAD in the distribution of first-order branch vessels were 71%, 67% and 68%, compared with 60%, 67% and 64% for patients with CABG. The sensitivity for isolated branch vessel CAD was 50% for patients without CABG, but only 29% for patients with CABG. The sensitivity and specificity for CAD in the distribution of branch vessels were similar for all patients for all stress test modalities and heart rate response (sensitivity, 64-69%; specificity, 61-69%). Stress SPECT MPI offers intermediate sensitivity, specificity and accuracy for the detection of CAD in the distribution of first-order coronary artery branch vessels. However, for isolated branch vessel CAD, stress SPECT has a lower sensitivity, particularly in patients with previous CABG.

Coronary Angiography↗
PubMed2002

Optimal designs of two-stage studies for estimation of sensitivity, specificity and positive predictive value.

The cost efficiency of estimation of sensitivity, specificity and positive predictive value from two-stage sampling designs is considered, assuming a relatively cheap test classifies first-stage subjects into several categories and an expensive gold standard is applied at stage two. Simple variance formulae are derived and used to find optimal designs for a given cost ratio. The utility of two-stage designs is measured by the reduction in variances compared with one-stage simple random designs. Separate second-stage design is also compared with proportional allocation (PA). The maximum percentage reductions in variance from two-stage designs for sensitivity, specificity and positive predictive value estimation are P per cent, (1-P) per cent and W, respectively, where P is the population prevalence of disease and W the population percentage of test negatives. The optimum allocation of stage-two resources is not obvious: the optimum proportion of true cases at stage two may even be less than under PA. PA is near optimal for sensitivity estimation in most cases when prevalence is low, but inefficient compared with the optimal scheme for specificity.

Asthma↗
PubMed1995

Detection of P-glycoprotein with a rapid flow cytometric functional assay using Fluo-3: evaluation of sensitivity, specificity and feasibility in multiparametric analysis.

The specificity and sensitivity of a flow cytometric assay simultaneously measuring expression and transport function of the multidrug resistance associated P-glycoprotein (Pgp) was evaluated. The monoclonal antibody (mAb), MRK16 was used to detect phenotypic Pgp expression while Fluo-3-AM was used as a fluorescent substrate in a Pgp functional transport assay. The specificity of the functional assay was examined in two vinblastine selected human leukemic cell lines (K562/VLB2.5 and CCRF-CEM/VLB50) with acquired Pgp overexpression. Downmodulation of Pgp function in these cell lines could be demonstrated with different substances (verapamil, vinblastine, trifluoperazine, cyclosporin A, progesterone and quinidine) and was proven to be consistently higher in the vinblastine selected cells than in their non-selected drug sensitive counterparts. Unexpectedly, modulator activity was also observed in drug sensitive K562 and CCRF-CEM cell lines despite the inability to detect Pgp in those cells by MRK16 flow cytometrically. Low level expression of the MDR1 gene encoding Pgp in sensitive K562 cells was however demonstrated with a sensitive RT-PCR procedure. The small effect of Pgp modulators in non-drug selected cells could therefore be attributed to low level basal expression of Pgp and illustrates the sensitivity of the functional assay. Also, the effect of various Pgp modulators on Pgp function was more pronounced in a subpopulation of Pgp expressing lymphocytes than in lymphocytes which did not express Pgp. Finally, a correlation was found between discrete variations in Pgp expression and Pgp function of CD4+ lymphocytes, underscoring the feasibility of the functional assay in a triple parametric procedure. The triple parametric assay holds promise to detect Pgp expression and function in clinical samples containing mixtures of malignant and non-malignant cells.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1997

Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence.

The sensitivity, specificity and likelihood ratios of binary diagnostic tests are often thought of as being independent of disease prevalence. Empirical studies, however, have frequently revealed substantial variation of these measures for the same diagnostic test in different populations. One reason for this discrepancy is related to the fact that only few diagnostic tests are inherently dichotomous. The majority of tests are based on categorization of individuals according to one or several underlying continuous traits. For these tests, the magnitude of diagnostic misclassification depends not only on the magnitude of the measurement or perception error of the underlying trait(s), but also on the distribution of the underlying trait(s) in the population relative to the diagnostic cutpoint. Since this distribution also determines prevalence of the disease in the population, diagnostic misclassification and disease prevalence are related for this type of test. We assess the variation of various measures of validity of diagnostic tests with disease prevalence for simple models of the distribution of the underlying trait(s) and the measurement or perception error. We illustrate that variation with disease prevalence is typically strong for sensitivity and specificity, and even more so for the likelihood ratios. Although positive and negative predictive values also strongly vary with disease prevalence, this variation is usually less pronounced than one would expect if sensitivity and specificity were independent of disease prevalence.

Data Interpretation, Statistical↗
PubMed2004

Sensitivity, specificity, positive predictive value, and negative predictive value of the dipyridamole sestamibi stress test comparing arterial to vein conduits.

STUDY OBJECTIVES: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dipyridamole stress test (DSST) in predicting > or = 50% obstruction of an internal mammary artery or new native coronary artery disease (CAD) compared with saphenous vein graft obstruction > or = 50% in patients with prior coronary artery surgery and symptoms. DESIGN: In 144 patients with prior coronary artery surgery who underwent a DSST within 8 +/- 7 days of coronary angiography performed because of cardiac symptoms, we investigated the sensitivity, specificity, PPV, and NPV of the DSST in predicting > or = 50% obstruction of an internal mammary artery or new native CAD (201 total arterial conduits) vs > or = 50% obstruction of saphenous vein grafts (total saphenous grafts = 246). SETTING: A university hospital. PATIENTS: The 144 patients included 88 men and 56 women, mean age 68 +/- 9 years (+/- SD). RESULTS: The DSST had a sensitivity of 81%, a specificity of 87%, a PPV of 84%, and a NPV of 84% in predicting > or = 50% obstruction of an internal mammary artery or new native CAD. The DSST had a sensitivity of 88%, a specificity of 82%, a PPV of 86%, and a NPV of 85% in predicting > or = 50% obstruction of saphenous vein grafts. CONCLUSION: There was no significant difference in sensitivity, specificity, PPV, or NPV of the DSST in predicting > or = 50% obstruction of an internal mammary artery or new native CAD vs predicting > or = 50% obstruction of saphenous vein grafts in patients with prior coronary artery surgery and cardiac symptoms.

Adult↗
PubMed1992

The logistic modeling of sensitivity, specificity, and predictive value of a diagnostic test.

A method is described for modeling the sensitivity, specificity, and positive and negative predictive values of a diagnostic test. To model sensitivity and specificity, the dependent variable (Y) is defined to be the dichotomous results of the screening test, and the presence or absence of disease, as defined by the "gold standard", is included as a binary explanatory variable (X1), along with variables used to define the subgroups of interest. The sensitivity of the screening test may then be estimated using logistic regression procedures. Modeled estimates of the specificity and predictive values of the screening test may be similarly derived. Using data from a population-based study of peripheral arterial disease, the authors demonstrated empirically that this method may be useful for obtaining smoothed estimates of sensitivity, specificity, and predictive values. As an extension of this method, an approach to the modeling of the relative sensitivity of two screening tests is described, using data from a study of screening procedures for colorectal disease as an example.

Arterial Occlusive Diseases↗
PubMed2003

Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings.

PURPOSE: To evaluate the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of ultrasonography (US), Doppler US, and laboratory findings in the diagnosis of appendicitis. MATERIALS AND METHODS: A total of 125 consecutive patients suspected of having appendicitis were prospectively included for US appendiceal (diameter enlarged to 6 mm or greater, intraluminal fluid, lack of compressibility) and periappendiceal (periileal inflammatory changes, cecal wall thickening, periileal lymph nodes, peritoneal fluid) evaluation, Doppler US evaluation (appendiceal wall signal), and laboratory assessment (leukocytosis, C-reactive protein [CRP]). Definite diagnoses were established at surgery in 61 patients, at endoscopy with biopsy in two patients, and at clinical follow-up in 62 patients. RESULTS: The prevalence of appendicitis was 46%. The appendix was identified with US in 86% of the patients, which included 96% of patients with and 72% of patients without appendicitis. The most accurate appendiceal finding for appendicitis was a diameter of 6 mm or larger, with a sensitivity, specificity, NPV, and PPV of 98%. The lack of visualization of the appendix with US had an NPV of 90%. The most accurate periappendiceal finding of appendicitis was the presence of inflammatory fat changes, with an NPV of 91% and a PPV of 76%, whereas other findings had both NPV and PPV less than 65%. An increase in both white blood cell (WBC) count and CRP level had a PPV of 71%, whereas combined normal WBC count and CRP value had an NPV of 84%. CONCLUSION: A threshold 6-mm diameter of the appendix under compression is the most accurate US finding for appendicitis and has high NPV and PPV.

Adolescent↗
PubMed1994

Mite allergen exposure is a risk for the incidence of specific sensitization.

BACKGROUND: Mite allergen exposure is essential for the process of specific allergic sensitization. However, it is not clear whether incidence of specific sensitization at school age depends on the level of mite antigen exposure. Therefore the relationship between mite allergen exposure and incidence of specific sensitization was investigated. METHODS: Eighteen hundred twelve primary school children were enrolled in a population-based 2-year follow-up study. In three consecutive skin prick tests (SPTs), each 12 months apart, sensitization to Dermatophagoides pteronyssinus (Dpt) and six non-Dpt allergens was ascertained. To assess exposure to Der p I between the first and second SPTs (period I) and the second and third SPTs (period II), the amount of antigen per gram of dust (taken from the children's mattresses was measured. By using the SPT reactions to Dpt as a basis, conversions after "no wheal" were classified as doubtful incidence (average yearly incidence = 6.7%) or definite incidence (average yearly incidence = 3.2%). Then, with the use of multiple logistic regression, the risk of exposure to Der p I (medians: 1.4 micrograms/gm in period I, 1.6 micrograms/gm in period II) was analyzed with adjustment being made for gender, low gestational age, parental atopy, and initial sensitization to non-Dpt allergens. RESULTS: Regarding doubtful incidence, the analysis failed to identify a reliable cutoff point of exposure. For definite incidence, the Der p I exposure represents a significant risk in the total population, starting from a concentration of 9 micrograms/gm. This effect is modified by an initial sensitization to non-Dpt allergens: for these children exposure to concentrations above 2 micrograms/gm poses a significant risk, whereas for the population without other initial sensitizations, only an extremely high cutoff limit (> 80 micrograms/gm) gains significance. CONCLUSION: Our data suggest that a concentration limit of 2 micrograms Der p I antigen per gram of dust should be regarded as minimal avoidance level for primary prevention in children with sensitization to other inhalant allergens.

Animals↗
PubMed2005

[Sensitivity, specificity and predictive value of hearing complaints].

This study assessed the sensitivity, specificity and predictive value of hearing complaints in outpatients attending an university ear, nose and throat clinic. A cross-sectional study was carried out in Canoas, Southern Brazil, from 1999 to 2002. Seven-hundred and ninety-five subjects who underwent the audiometric test were analyzed. The results showed that the complaint of hearing loss presented 80.9% sensitivity, 69.6% specificity and 86.5% positive predictive value and 60.4% negative predictive value. Despite its subjective character, the audiometric test can be considered a reliable diagnostic tool and should be used due to its low cost compared to the new technologies.

Adolescent↗
PubMed2003

Sensitivity, specificity, and efficiency in detecting opiates in oral fluid with the Cozart Opiate Microplate EIA and GC-MS following controlled codeine administration.

Oral fluid specimens (N = 1406) were collected from 19 subjects prior to and up to 72 h following controlled administration of oral codeine. Volunteers provided informed consent to participate in this National Institute on Drug Abuse Institutional Review Board-approved protocol. A modification of Cozart Microplate Opiate EIA Oral Fluid Kit (Opiate ELISA), employing codeine calibrators, was used for semiquantitative analysis of opiates, followed by gas chromatography-mass spectrometry (GC-MS) for the confirmation and quantitation of codeine, norcodeine, morphine, and normorphine in oral fluid. GC-MS limits of detection and quantitation were 2.5 microg/L for all analytes. The Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed a 40-microg/L opiate screening and a 40-microg/L morphine or codeine confirmation cutoff for the detection of opiate use. Oral fluid opiate screening and confirmation cutoffs of 30 micro g/L are in use in the U.K. Utilizing 2.5-, 20-, 30-, and 40-microg/L GC-MS cutoffs, 26%, 20%, 19%, and 18% of the oral fluid specimens were positive for codeine or one of its metabolites. Six Opiate ELISA/confirmation cutoff criteria (2.5/2.5, 10/2.5, 20/20, 30/20, 30/30, and 40/40 microg/L) were evaluated. Calculations for Opiate ELISA sensitivity, specificity, and efficiency were determined from the number of true-positive, true-negative, false-positive, and false-negative results at each screening/confirmation cutoff. Sensitivity, specificity, and efficiency for the lowest cutoff were 91.5%, 88.6%, and 89.3%. Application of the cutoff currently used in the U.K. yielded sensitivity, specificity, and efficiency results of 79.7%, 99.0%, and 95.4% and similar results of 76.7%, 99.1%, and 95.1% when applying the SAMHSA criteria. These data indicate that the Opiate ELISA efficiently detects oral codeine use. In addition, the data, collected following controlled oral codeine administration, may aid in the interpretation of opiate oral fluid test results and in the selection of appropriate oral fluid screening and confirmation cutoffs.

Administration, Oral↗
PubMed1987

Multiple sensory neuronal correlates of site-specific sensitization in Aplysia.

Noxious stimulation of a restricted site on the skin of Aplysia (training) causes site-specific sensitization of the tail-withdrawal reflex that is associated with several sensory correlates that are evident both 10 min and 2 hr after training. First, extracellularly recorded afferent activity evoked by test stimulation of the trained site increases, indicating peripheral sensory changes. Second, central sensory alterations are manifested by tail sensory neurons within the pleural VC cluster that innervate the trained site and are activated during training. These mechanosensory/nociceptive cells display a number of differences from unactivated tail sensory neurons innervating other sites: slow depolarization of the soma observed immediately after training, decrease in soma action potential threshold, and enhancement of monosynaptic EPSPs to identified motor neurons. Noxious stimulation of a more extensive region also produces site-specific sensitization of the tail-withdrawal reflex and site-specific enhancement of EPSP amplitude measured 1 d after training. This training produced a novel cellular correlate of behavioral enhancement in Aplysia--regenerative bursting responses (2-35 spikes) in response to brief depolarization of the sensory neuron soma. The changes in peripheral and central excitability appear similar to changes associated with mammalian models of primary hyperalgesia. Site-specific enhancement of nociceptive signaling also occurs during aversive associative conditioning in a noxious unconditioned stimulus (US) pathway. These site-specific changes involve activity-dependent extrinsic modulation (ADEM) of the VC sensory neurons, suggesting a close relationship to changes underlying associative conditioning in conditioned stimulus (CS) pathways in Aplysia.

Animals↗
PubMed1982

Detection of left ventricular thrombus by two-dimensional echocardiography: sensitivity, specificity, and causes of uncertainty.

To define the sensitivity, specificity and predictive accuracy of two-dimensional echocardiographic detection of left ventricular thrombus, the echocardiograms of 78 patients who had independent proof of the presence or absence of a left ventricular thrombus were interpreted without knowledge of any clinical data. The presence of thrombus was established by autopsy in four patients, by aneurysmectomy in three, and by indium-111 platelet imaging in 15; the absence of thrombus was proved by autopsy in 55 patients and by aneurysmectomy in one patient. The characteristics of true-positive and false-positive echocardiograms, interobserver variability, and clinical features associated with proved thrombus were also defined. The echocardiogram was positive for thrombus in 22 patients, equivocal in seven and negative in 49. For detection of thrombus, a positive or equivocal echocardiogram had a sensitivity of 95% (21 of 22), a specificity of 86% (48 of 56), and a predictive value of 72% (21 of 29); the predictive value of a negative study was 98% (48 of 49). Considering positive and equivocal studies separately, the predictive value of a positive study was 86% (19 of 22), while that of an equivocal study was only 29% (two of seven). Compared with patients who had no thrombus, patients with proved thrombus had a higher prevalence of electrocardiographic transmural anterior infarction (86% vs 13%), left ventricular aneurysm (73% vs 5%), and clinical systemic emboli (36% vs 7%) (all p less than 0.05). These clinical features help to identify a subset of patients most likely to have left ventricular thrombi who may benefit from echocardiography. Two-dimensional echocardiography is highly sensitive in detecting left ventricular thrombus, but false-positive studies are relatively common. Several echocardiographic criteria derived from analysis of the true and false positives in this study may help minimize diagnostic errors.

Diagnosis, Differential↗
PubMed1982

Sensitivity, specificity, and risk of diagnostic procedures in a canine model of Streptococcus pneumoniae pneumonia.

A canine model in which unilateral Streptococcus pneumoniae pneumonia was induced was used to evaluate the sensitivity, specificity, and risk of various technics proposed for the diagnosis of pulmonary infection. Control and infected animals were studied during spontaneous and mechanical ventilation. We found that three procedures provided a reasonable degree of combined specificity and sensitivity: transthoracic needle aspiration (TTN), catheter-brush biopsy (CBB), and transbronchial biopsy (TBB). Transtracheal aspiration, although sensitive, was consistently low in specificity, whereas TTN provided the highest sensitivity/specificity. Both CBB and TBB provided almost the same results in intubated animals, but specificity was lower in nonintubated animals. Gram-stained smears obtained by TTN, CBB, and TBB were highly specific, but often negative. The only risk encountered was pneumothorax. The TTN was associated with a 20 to 30% risk of pneumothorax; CBB and TBB did not appear to induce pneumothorax. These studies provide the first animal data regarding the comparative yield/risk of these diagnostic approaches. As such, they may prove useful in the design of future human investigations.

Animals↗
PubMed2004

A sensitive, specific, and cost-effective multiplex reverse transcriptase-PCR assay for the detection of seven common respiratory viruses in respiratory samples.

Cell culture and direct fluorescent antibody (DFA) assays have been traditionally used for the laboratory diagnosis of respiratory viral infections. Multiplex reverse transcriptase polymerase chain reaction (m-RT-PCR) is a sensitive, specific, and rapid method for detecting several DNA and RNA viruses in a single specimen. We developed a m-RT-PCR assay that utilizes multiple virus-specific primer pairs in a single reaction mix combined with an enzyme-linked amplicon hybridization assay (ELAHA) using virus-specific probes targeting unique gene sequences for each virus. Using this m-RT-PCR-ELAHA, we examined the presence of seven respiratory viruses in 598 nasopharyngeal aspirate (NPA) samples from patients with suspected respiratory infection. The specificity of each assay was 100%. The sensitivity of the DFA was 79.7% and the combined DFA/culture amplified-DFA (CA-DFA) was 88.6% when compared to the m-RT-PCR-ELAHA. Of the 598 NPA specimens screened by m-RT-PCR-ELAHA, 3% were positive for adenovirus (ADV), 2% for influenza A (Flu A) virus, 0.3% for influenza B (Flu B) virus, 1% for parainfluenza type 1 virus (PIV1), 1% for parainfluenza type 2 virus (PIV2), 5.5% for parainfluenza type 3 virus (PIV3), and 21% for respiratory syncytial virus (RSV). The enhanced sensitivity, specificity, rapid result turnaround time and reduced expense of the m-RT-PCR-ELAHA compared to DFA and CA-DFA, suggests that this assay would be a significant improvement over traditional assays for the detection of respiratory viruses in a clinical laboratory.

Adolescent↗
PubMed2001

Estimation of sensitivity, specificity and predictive values of two serologic tests for the detection of antibodies against Actinobacillus pleuropneumoniae serotype 2 in the absence of a reference test (gold standard).

Latent-class models were used to determine the sensitivity, specificity and predictive values of a polyclonal blocking enzyme-linked immunosorbent assay (ELISA) and a modified complement-fixation test (CFT) when there was no reference test. The tests were used for detection of antibodies against Actinobacillus pleuropneumoniae serotype 2 in a survey of respiratory diseases in Danish finishing pigs. The estimates were obtained by maximum-likelihood and also by a Bayesian method (implemented with Gibbs sampling). Possible dependence of diagnostic errors was investigated by comparing models where independence was assumed to models allowing for conditional dependence, given the true disease status. No strong evidence of conditional dependence in either test sensitivity or specificity was found. Assuming independence, maximum-likelihood estimates and 95% confidence intervals of the sensitivity and specificity of the ELISA were 100% and 92.8% (90.1-95.5%) and the corresponding values of the CFT were 90.6% (85.8-95.4%) and 98.6% (98.0-99.3%), respectively. Bayesian estimates and posterior 95% credible intervals of the sensitivity and specificity of the ELISA were 99.7% (98.7-100%) and 92.7% (89.9-95.3%) and of the CFT were 90.6% (86.0-95.3%) and 98.7% (98.0-99.3%). The sensitivity and specificity of a combined test, where the CFT is subsequently applied to the pig sera that test positive in the ELISA, were estimated at 90.2% (85.6-95.0%) and 99.9% (99.8-100%), respectively. The cost of the combined test was less than the cost of the use of the CFT alone, at prevalences <54%. Prevalences and predictive values and their 95% limits were estimated in six sub-samples of data. The estimates of sensitivity and specificity obtained in the present investigation generally validate those reported from other sources.

Actinobacillus Infections↗
PubMed1995

[Survey of clinical diagnoses and autopsy findings. Autopsy findings and sensitivity, specificity and predictive values for clinical diagnosis during the periods 1 July 1980-30 June 1081 and 1 July 1990-30 June 1993].

The sensitivity, specificity and clinical accuracy of clinical diagnoses were determined and compared for two periods of time: 1.7.1980-30.6.1981 and 1.7.1990-30.6.1993 based on the analysis of 286 and 138 autopsies respectively. The autopsy rate decreased from 82.7% in the first period to 11.2% in the second. The first period shows a generally higher sensitivity and accuracy for positive diagnosis. Both periods reveal the lowest sensitivity for pulmonary embolism and the lowest accuracy for positive clinical diagnosis of pneumonia/bronchopneumonia. For malignancies and arteriosclerotic heart diseases significant discrepancy between the periods was demonstrated using the chi 2-test. The results are influenced by low autopsy rates causing fewer true-positive diagnoses and a declining sensitivity. This type of study is a useful tool for demonstrating changes in the diagnostic procedure. The present investigation demonstrates a need for further analysis of malignancies to explain the simultaneous decrease in sensitivity, specificity and accuracy in spite of an increasing number of malignancies in autopsy findings.

Autopsy↗