Sensitivity and Specificity
Medical tests sensitivity is the extent to which actual positives are not overlooked (so false negatives are few), and specificity is the extent to which actual negatives are classified as such (so false positives are few). Thus a highly sensitive test rarely overlooks an actual positive (for example, showing "nothing bad" despite something bad existing); a highly specific test rarely registers a positive classification for anything that is not the target of testing (for example, finding one bacterial species and mistaking it for another closely related one that is the true target); and a test that is highly sensitive and highly specific does both, so it "rarely overlooks a thing that it is looking for" and it "rarely mistakes anything else for that thing." Because most medical tests do not have sensitivity and specificity values above 99%, "rarely" does not equate to certainty. But for practical reasons, tests with sensitivity and specificity values above 90% have high credibility, albeit usually no certainty, in differential diagnosis.
For any test, there is usually a trade-off between the measures – for instance, in airport security, since testing of passengers is for potential threats to safety, scanners may be set to trigger alarms on low-risk items like belt buckles and keys (low specificity) in order to increase the probability of identifying dangerous objects and minimize the risk of missing objects that do pose a threat (high sensitivity)
Application to screening study
Imagine a study evaluating a new test that screens people for a disease. Each person taking the test either has or does not have the disease. The test outcome can be positive (classifying the person as having the disease) or negative (classifying the person as not having the disease). The test results for each subject may or may not match the subject's actual status. In that setting:
- True positive: Sick people correctly identified as sick
- False positive: Healthy people incorrectly identified as sick
- True negative: Healthy people correctly identified as healthy
- False negative: Sick people incorrectly identified as healthy
In general, Positive = identified and negative = rejected. Therefore:
- True positive = correctly identified
- False positive = incorrectly identified
- True negative = correctly rejected
- False negative = incorrectly rejected
Medical diagnosis
In medical diagnosis, test sensitivity is the ability of a test to correctly identify those with the disease (true positive rate), whereas test specificity is the ability of the test to correctly identify those without the disease (true negative rate). If 100 patients known to have a disease were tested, and 43 test positive, then the test has 43% sensitivity. If 100 with no disease are tested and 96 return a negative result, then the test has 96% specificity. Sensitivity and specificity are prevalence-independent test characteristics, as their values are intrinsic to the test and do not depend on the disease prevalence in the population of interest
