Sensitivity and specificity

In medicine and statistics, sensitivity and specificity mathematically describe the accuracy of a test that reports the presence or absence of a medical condition. If individuals who have the condition are considered "positive" and those who do not are considered "negative", then sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives:

Sensitivity (true positive rate) is the probability of a positive test result, conditioned on the individual truly being positive.
Specificity (true negative rate) is the probability of a negative test result, conditioned on the individual truly being negative.

If the true status of the condition cannot be known, sensitivity and specificity can be defined relative to a "gold standard test" which is assumed correct. For all testing, both diagnoses and screening, there is usually a trade-off between sensitivity and specificity, such that higher sensitivities will mean lower specificities and vice versa.

A test which reliably detects the presence of a condition, resulting in a high number of true positives and low number of false negatives, will have a high sensitivity. This is especially important when the consequence of failing to treat the condition is serious and/or the treatment is very effective and has minimal side effects.

A test which reliably excludes individuals who do not have the condition, resulting in a high number of true negatives and low number of false positives, will have a high specificity. This is especially important when people who are identified as having a condition may be subjected to more testing, expense, stigma, anxiety, etc.

The terms "sensitivity" and "specificity" were introduced by American biostatistician Jacob Yerushalmy in 1947.

Terminology and derivations
from a confusion matrix
condition positive (P) the number of real positive cases in the data condition negative (N) the number of real negative cases in the data true positive (TP) A test result that correctly indicates the presence of a condition or characteristic true negative (TN) A test result that correctly indicates the absence of a condition or characteristic false positive (FP), Type I error A test result which wrongly indicates that a particular condition or attribute is present false negative (FN), Type II error A test result which wrongly indicates that a particular condition or attribute is absent sensitivity, recall, hit rate, or true positive rate (TPR) $\mathrm {TPR} ={\frac {\mathrm {TP} }{\mathrm {P} }}={\frac {\mathrm {TP} }{\mathrm {TP} +\mathrm {FN} }}=1-\mathrm {FNR}$ specificity, selectivity or true negative rate (TNR) $\mathrm {TNR} ={\frac {\mathrm {TN} }{\mathrm {N} }}={\frac {\mathrm {TN} }{\mathrm {TN} +\mathrm {FP} }}=1-\mathrm {FPR}$ precision or positive predictive value (PPV) $\mathrm {PPV} ={\frac {\mathrm {TP} }{\mathrm {TP} +\mathrm {FP} }}=1-\mathrm {FDR}$ negative predictive value (NPV) $\mathrm {NPV} ={\frac {\mathrm {TN} }{\mathrm {TN} +\mathrm {FN} }}=1-\mathrm {FOR}$ miss rate or false negative rate (FNR) $\mathrm {FNR} ={\frac {\mathrm {FN} }{\mathrm {P} }}={\frac {\mathrm {FN} }{\mathrm {FN} +\mathrm {TP} }}=1-\mathrm {TPR}$ fall-out or false positive rate (FPR) $\mathrm {FPR} ={\frac {\mathrm {FP} }{\mathrm {N} }}={\frac {\mathrm {FP} }{\mathrm {FP} +\mathrm {TN} }}=1-\mathrm {TNR}$ false discovery rate (FDR) $\mathrm {FDR} ={\frac {\mathrm {FP} }{\mathrm {FP} +\mathrm {TP} }}=1-\mathrm {PPV}$ false omission rate (FOR) $\mathrm {FOR} ={\frac {\mathrm {FN} }{\mathrm {FN} +\mathrm {TN} }}=1-\mathrm {NPV}$ Positive likelihood ratio (LR+) $\mathrm {LR+} ={\frac {\mathrm {TPR} }{\mathrm {FPR} }}$ Negative likelihood ratio (LR-) $\mathrm {LR-} ={\frac {\mathrm {FNR} }{\mathrm {TNR} }}$ prevalence threshold (PT) $\mathrm {PT} ={\frac {\sqrt {\mathrm {FPR} }}{{\sqrt {\mathrm {TPR} }}+{\sqrt {\mathrm {FPR} }}}}$ threat score (TS) or critical success index (CSI) $\mathrm {TS} ={\frac {\mathrm {TP} }{\mathrm {TP} +\mathrm {FN} +\mathrm {FP} }}$ Prevalence ${\frac {\mathrm {P} }{\mathrm {P} +\mathrm {N} }}$ accuracy (ACC) $\mathrm {ACC} ={\frac {\mathrm {TP} +\mathrm {TN} }{\mathrm {P} +\mathrm {N} }}={\frac {\mathrm {TP} +\mathrm {TN} }{\mathrm {TP} +\mathrm {TN} +\mathrm {FP} +\mathrm {FN} }}$ balanced accuracy (BA) $\mathrm {BA} ={\frac {\mathrm {TPR} +\mathrm {TNR} }{2}}$ F1 score is the harmonic mean of precision and sensitivity: $\mathrm {F} _{1}=2\times {\frac {\mathrm {PPV} \times \mathrm {TPR} }{\mathrm {PPV} +\mathrm {TPR} }}={\frac {2\mathrm {TP} }{2\mathrm {TP} +\mathrm {FP} +\mathrm {FN} }}$ phi coefficient (φ or r_φ) or Matthews correlation coefficient (MCC) $\mathrm {MCC} ={\frac {\mathrm {TP} \times \mathrm {TN} -\mathrm {FP} \times \mathrm {FN} }{\sqrt {(\mathrm {TP} +\mathrm {FP} )(\mathrm {TP} +\mathrm {FN} )(\mathrm {TN} +\mathrm {FP} )(\mathrm {TN} +\mathrm {FN} )}}}$ Fowlkes–Mallows index (FM) $\mathrm {FM} =\mathrm {{\sqrt {{\frac {TP}{TP+FP}}\times {\frac {TP}{TP+FN}}}}={\sqrt {PPV\times TPR}}}$ informedness or bookmaker informedness (BM) $\mathrm {BM} =\mathrm {TPR} +\mathrm {TNR} -1$ markedness (MK) or deltaP (Δp) $\mathrm {MK} =\mathrm {PPV} +\mathrm {NPV} -1$ Diagnostic odds ratio (DOR) $\mathrm {DOR} ={\frac {\mathrm {LR+} }{\mathrm {LR-} }}$ Sources: Fawcett (2006), Piryonesi and El-Diraby (2020), Powers (2011), Ting (2011), CAWCR, D. Chicco & G. Jurman (2020, 2021, 2023), Tharwat (2018). Balayla (2020)

There are different definitions within laboratory quality control, wherein "analytical sensitivity" is defined as the smallest amount of substance in a sample that can accurately be measured by an assay (synonymously to detection limit), and "analytical specificity" is defined as the ability of an assay to measure one particular organism or substance, rather than others. However, this article deals with diagnostic sensitivity and specificity as defined at top.

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