Evaluation of Diagnostic Tests Using Information Theory for Multi-Class Diagnostic Problems and its Application for the Detection of Occlusal Caries Lesions

Abstract

Diagnostic tests are widely used in medical science for diagnosing the presence or absence of a disease. These tests may not discriminate between subjects with and without the disease or disorder with perfect accuracy. Several methods are available to evaluate the performance of diagnostic tests when the purpose of the test is to discriminate between two possible disease states. Different performance indices have been proposed to determine the accuracy of diagnostic tests when both the disease state and the test result are binary. However, in some cases, the disease state may have more than two categories. For this reason, there is a need for other methods to characterize the accuracy of diagnostic tests. In this study, we propose a method which is useful in terms of selecting the most appropriate diagnostic test when the disease state and test results have three or more classes. In this study, information content (IC) and proportional reduction in diagnostic uncertainty (PRDU) were introduced as measures of diagnostic test accuracy. To demonstrate the applicability of these statistics, we evaluated the diagnostic performance of four different diagnostic methods which are used for dental caries detection: visual inspection, radiography, laser fluorescence (LF) and micro-computed tomography (M-CT) examination.Background: Several methods are available to evaluate the performance of the tests when the purpose of the diagnostic test is to discriminate between two possible disease states. However multi-class diagnostic problems frequently appear in many areas of medical science. Hence, there is a need for methods which will enable us to characterize the accuracy of diagnostic tests when there are more than two possible disease states. Aims: To show that two information theory measures, information content (IC) and proportional reduction in diagnostic uncertainty (PRDU), can be used for the evaluation of the performance of diagnostic tests for multi-class diagnostic problems that may appear in different areas of medical science. Study Design: Diagnostic accuracy study. Methods: Sixty freshly extracted permanent human molar and premolar teeth suspected to have occlusal caries lesions were selected for the study and were assessed by two experienced examiners. Each examiner performed two evaluations. Histological examination was used as the gold standard. The scores of the histological examination were defined as sound (n=11), enamel caries (n=22) and dentin caries (n=27). Diagnostic performance of i) visual inspection, ii) radiography, iii) laser fluorescence (LF) and iv) micro-computed tomography (M-CT) caries detection methods was evaluated by calculating IC and PRDU. Results: Micro-computed tomography examination was the best method among the diagnostic techniques for the diagnosis of occlusal caries in terms of both IC and PRDU. M-CT examination supplied the maximum diagnostic information about the diagnosis of occlusal caries in the first (IC: 1.056; p<0.05), (PRDU: 70.5%) and second evaluation (IC: 1.105; p<0.05),...

Validity of micro-CT for in vitro caries detection: a systematic review and meta-analysis

“…4,7,10,21 Overall, results from the included studies showed micro-CT as accurate as histology for diagnose caries lesion from sound tissue and for depth of caries lesion. 3,[6][7][8][9][10][11]21,22 However, in some studies micro-CT was not accurate to assess enamel lesions, 5 did not classify adequately the depth of the lesion 12 and showed moderate agreement with histology for enamel caries detection. 4…”

“…The search identified 270 records and after removing duplication, 187 remained being selected to full-text analysis. In total, 12 studies were selected [3][4][5][6][7][8][9][10][11][12]21,22 and from these, three studies 4,10,11 were retained to meta-analysis.…”

“…Studies were conducted from 2009 3,22 to 2018 12 and evaluated from 20 4 to 140, 10 permanent teeth, [3][4][5][6][9][10][11][12]21,22 primary teeth 7 or both permanent and primary teeth. Six studies analyzed the presence of caries in occlusal surface, 3,5,6,10,21,22 five in proximal 4,7,8,11,12 and one in both, occlusal and proximal surfaces 10 (Table 1).…”

“…2 However, in the last years the potential of micro-CT as a substitute for histological exam as the reference standard has been examined by several studies. [3][4][5][6][7][8][9][10][11][12] Soviero et al 7 affirmed that micro-CT and histological analysis function are reference standard in a similar manner. The authors verified that micro-CT is very sensitive for the detection of caries lesions in enamel and for differentiation of lesions in enamel and dentin in vitro.…”

Beyond kappa: an informational index for diagnostic agreement in dichotomous and multivalue ordered-categorical ratings

“…While IT tools have widely been suggested in medical statistics and diagnostics (e.g. see [ 4 , 5 , 8 – 10 , 35 – 37 , 46 , 47 ]), they have not been used as broadly in relation with agreement measures. On this research track, we can only mention [ 31 ], where a normalised weighted MI is used as an index of intercoder agreement , and [ 29 ], which uses MI to quantify the information shared between outcomes of multiple healthcare surveys.…”