Download PDF
Methods Inf Med 1990; 29(03): 213-220
DOI: 10.1055/s-0038-1634788
Statistical Analysis
Schattauer GmbH

Sensitivity and Specificity of Acid Phosphatase to Detect Prostate Cancer Using Data from a Hospital Information System

Johanna H. M. Zwetsloot-Schonk
1   Department of Clinical Oncology, Leiden, The Netherlands
2   Central Department of Information Processing, Leiden, The Netherlands
,
J. Hermans
3   Department of Medical Statistics, Leiden, The Netherlands
,
Marijke Frolich
4   Central Laboratory for Clinical Chemistry, Leiden, The Netherlands
,
P. Snitker
5   Central Development and Support Group Hospital Information Systems BAZIS, Leiden, The Netherlands
,
J. H. M. Souverijn
4   Central Laboratory for Clinical Chemistry, Leiden, The Netherlands
,
J. Zwartendijk
6   Department of Urology, Leiden University Hospital, Leiden, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
07 February 2018 (online)

    Permissions and Reprints

Abstract

Indices of diagnostic tests, such as sensitivity and specificity, should be determined using diagnostic test results of patients tested in clinical practice. Hospital information systems that store data on diagnostic tests and diagnoses might be used for sampling the desired study population and in the actual process of collecting the data.

This paper presents, as an example, a study calculating the sensitivity and specificity of the prostate-specific acid phosphatase test. All data needed in the study were obtained from the hospital information system of Leiden University Hospital. The final health status of each patient was assessed by the cancer registry of the system. The reason for ordering the test was deduced from data on histopathological examinations of prostatic tissue. The actual selections made from the central database are described in dataflow diagrams. The sensitivity of the test was found to be 0.34 and the specificity 0.88, using a discrimination value o f 1.00 U/I. The impact of the reason for ordering the test on the specificity is illustrated. Possible biases of these measured values are discussed.

Key-Words

Prostatic Acid-Phosphatase Test - Sensitivity - Specificity - Hospital Information System
 

  • REFERENCES

  • 1 Hlatky MA, Mark DB, Harrell FE, Lee KL, Califf RM, Pryor DB. Rethinking sensitivity and specificity. Am J Cardiol 1987; 59: 1195-88.
    CrossrefPubMedGoogle Scholar
  • 2 Ransohoff DF, Feinstein A. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 1978; 299: 926-30.
    CrossrefPubMedGoogle Scholar
  • 3 Zwetsloot-Schonk JHM. Use of hospital information systems to determine the characteristics of diagnostic tests. Meth Inform Med 1990; 29: 205-12.
    PubMedGoogle Scholar
  • 4 Linnet K. A review on the methodology for assessing diagnostic tests. Clin Chem 1988; 34: 1379-86.
    PubMedGoogle Scholar
  • 5 Centraal Bureau voor de Statistiek. Morbiditeit en Mortaliteit. Maandbericht Gezondheid 1982; 01: 5-55 (in Dutch).
    PubMedGoogle Scholar
  • 6 George NLR. Natural history of localized prostatic cancer managed by conservative therapy alone. Lancet 1988; i: 494-6.
    PubMedGoogle Scholar
  • 7 Hanash KA, Utz DC, Cook EN, Taylor WF, Titus JL. Carcinoma of the prostate: a 15 yeasr follow-up. J Urol 1972; 107: 450-3.
    CrossrefPubMedGoogle Scholar
  • 8 Aristizabal SA, Steinbronn D, Heusinkveld RS. External beam radiotherapy in cancer of the prostate. Radiother Oncol 1984; 01: 309-15.
    CrossrefPubMedGoogle Scholar
  • 9 Boxer RJ, Kaufman II, Goodwin WE. Radical prostatectomy for carcinoma of the prostate: 1951-1976. A review of 329 patients. J Urol 1977; 117: 208-13.
    CrossrefPubMedGoogle Scholar
  • 10 Gibbons RP, Correa RJ, Brannen GE, Mason JT. Total prostatectomy for localized prostatic cancer. J Urol 1984; 131: 73-5.
    CrossrefPubMedGoogle Scholar
  • 11 Grossman HB, Batata M, Hilaris B, Whitmore WF. 125I Implantation for carcinoma of prostate. Further follow-up of first 100 cases. Urology 1982; 20: 591-8.
    CrossrefPubMedGoogle Scholar
  • 12 Herr HW. The patient, disease status, and treatment options for prostate cancer: stages B 1 and B2. Prostate 1983; 04: 447-59.
    CrossrefPubMedGoogle Scholar
  • 13 Murphy GP. The diagnosis of prostatic cancer. Cancer 1976; 37: 589-96.
    CrossrefPubMedGoogle Scholar
  • 14 Yarn LT. Clinical significance of the human acid phosphatases. Arn J Med 1974; 56: 604-12.
    PubMedGoogle Scholar
  • 15 Gutman AB, Gutman EB. An acid phosphatase occurring in the serum of patients with metastasizing carcinoma of the prostate gland. J Clin Invest 1938; 17: 473-8.
    CrossrefPubMedGoogle Scholar
  • 16 Choe BK, Rose NR, Pontes EJ. Irnmunoenzyme assay for human prostatic acid phosphatase. Proc Soc Exp Biol Med 1979; 162: 396-400.
    CrossrefPubMedGoogle Scholar
  • 17 Chu TM, Wang MC, Scott WW, Gibbons RP, Johnson DE, Schmidt JD, Loening SA, Prout GR, Murphy GP. Irnmunochernical detection of serum prostatic acid phosphatase. Invest Urol 1978; 15: 319-23.
    PubMedGoogle Scholar
  • 18 Cooper JE. The radio-irnrnunochemical measurement of prostate acid phosphatase: current state of the art. Urol Clin North Arn 1980; 07: 653.
    PubMedGoogle Scholar
  • 19 Foti AG, Cooper JF, Herschrnan H, Malvaez RR. Detection of prostatic cancer by solid-phase radioimrnunoassay of serum prostati acid phosphatase. N Engl J Med 1977; 297: 1357-61.
    CrossrefPubMedGoogle Scholar
  • 20 Lee CL, Wang MC, Murphy GP, Chu TM. A solid phase fluorescent immunoassay for human prostatic acid phosphatase. Cancer Res 1978; 38: 2871-8.
    PubMedGoogle Scholar
  • 21 Mensink HJA, Marrink J, Hendriks FR, van Zanten AK. Prostatic acid phosphatase: comparison of radioimmunoassay and enzyme activity assay. J Urol 1983; 129: 1136-40.
    CrossrefPubMedGoogle Scholar
  • 22 Romans NA, Rose NR, Tannenbaum M. Acid phosphatase new developments. Hum Path 1979; 10: 501-12.
    CrossrefPubMedGoogle Scholar
  • 23 Roy AV, Brower ME, Hayden JE. Sodium thymolphthalein rnonophosphate: A new acid phosphatase substrate with greater specificity for the prostatic enzyme in the serum. Clin Chern 1971; 17: 1093-102.
    PubMedGoogle Scholar
  • 24 deVries GP, Sanders GTB. Development and clinical evaluation of two immunoassays for prostatic Acid Phosphatase in Serum. Am J Clin Pathol 1982; 72: 189-95.
    PubMedGoogle Scholar
  • 25 Klein LA, Shapiro P. Role of acid phosphatase measurement in management of prostatic cancer. Urology 1981; 17: 550-3.
    CrossrefPubMedGoogle Scholar
  • 26 Pontes JE, Choe BK, Rose NR, Ercole C, Pierce JM. Clinical evaluation of immunological methods for detection of serum prostatic acid phosphatase. J Urol 1981; 126: 363-5.
    CrossrefPubMedGoogle Scholar
  • 27 Quinones GR, Rohner TJ, Drago JR, Demers LM. Will prostatic acid phosphatase determination by radioimmunoassay increase the diagnoses of early prostatic cancer?. J Urol 1981; 125: 361-4.
    CrossrefPubMedGoogle Scholar
  • 28 Guinan P, Bush I, Ray V, Vieth R, Rao R, Bhatti R. The accuracy of the rectal examination in the diagnoses of prostate carcinoma. N Engl J Med 1980; 303: 499-503.
    CrossrefPubMedGoogle Scholar
  • 29 Bakker AR, Mal JL. Hospital information systems. Effective Health Care 1984; 01: 169-80.
    PubMedGoogle Scholar
  • 30 Kouwenberg JM, Bongers A, Bakker AR. Storage structure in a large database. In: Barber BF, Grerny F, Uberla K, Wagner G. eds. MlE 79. Berlin: Springer Verlag; 1979: 590-601.
    Google Scholar
  • 31 Zwetsloot-Schonk JHM, Snitker P, Vandenbroucke JP, Bakker AR. Using hospital Information in clinical epidemiological research. Med Inform 1989; 14: 53-62.
    PubMedGoogle Scholar
  • 32 Zwetsloot-Schonk JHM, van Stiphout WAHJ, Snitker P, van Es LA, Vandenbroucke JP. How to approach a hospital information system as sampling frame?. Selection of patients with a percutaneous renal biopsy. (Subm for publ)..
    PubMedGoogle Scholar
  • 33 Panzer RJ, Suchman AL, Griner PE. Work-up bias in prediction research. Med Decis Making 1987; 07: 115-9.
    CrossrefPubMedGoogle Scholar
  • 34 Cain KC, Greenes RA, Begg CE. Patientoriented performance measures of diagnostic tests: 3. U-factor. Med Decis Making 1984; 04: 33-46.
    CrossrefPubMedGoogle Scholar
  • 35 Doubilet P. A mathematical approach to interpretation and selection of diagnostic tests. Med Decis Making 1983; 03: 177-95.
    CrossrefPubMedGoogle Scholar
  • 36 Greenes RA, Chain KC, Begg CB. Patient-oriented performance measures of diagnostic tests: 1.Tools for prospetive evaluation of test order decisions. Med Decis Making 1984; 04: 7-15.
    CrossrefPubMedGoogle Scholar
  • 37 Greenes RA, Begg CB, Cain KC, Swets JA, Feehrer CE, McNeil BJ. Patientoriented performance measures of diagnostic tests: 2. Assignment potential and assignment strength. Med Decis Makin 1984; 04: 17-31.
    PubMedGoogle Scholar
  • 38 Griner PF, Mayewski RJ, Mushlin AI, Greenland P. Selection and interpretation of diagnostic tests and procedures. Ann Intern Med 1981; 94: 553-600.
    PubMedGoogle Scholar
  • 39 Fagan TJ. Nomogramm for Bayes’theorern. N Engl J Med 1975; 293: 257.
    CrossrefPubMedGoogle Scholar
  • 40 Greenes RA. Interactive microcomputer based graphical tools for physician decision support. Aids to test selection and interpretation and use of Bayes’theorem. Med Decis Making 1983; 03: 15-21.
    CrossrefPubMedGoogle Scholar
  • 41 Berwick DM. Toward an applied technology for quality measurement in health care. Med Decis Making 1988; 08: 253-8.
    CrossrefPubMedGoogle Scholar
  • 42 Fowkes FGR. Containing the use of diagnostic tests. Br Med J 1986; 290: 488-90.
    PubMedGoogle Scholar
  • 43 Phelps CE, Mushlin Al. Focussing Technology assessment using decision theory. Med Decis Making 1988; 08: 279-89.
    CrossrefPubMedGoogle Scholar
  • 44 Thompson MS. Evaluation of diagnostic procedures. A review of the issues. Evaluation of Program Planning 1981; 04: 385-96.
    PubMedGoogle Scholar
  • 45 Wennberg JE. Non-experimental methods in the assessment of efficacy. Med Decis Making 1988; 08: 175-6.
    CrossrefPubMedGoogle Scholar
  • 46 Wong ET. Cost-effective use of laboratory tests: a joint responsibility of clinicians and laboratorians. Clin Lab Med 1984; 04: 665-72.
    PubMedGoogle Scholar