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Nonetheless, we found that while visual scores were not as specific or as accurate as quantitative measures for discriminating patients with DLB from other neurologic diseases, demographic indexing to produce a hybrid visual score did significantly improve test specificity, to the point that indexed visual scores were statistically equivalent to quantified metrics for this purpose.
As such, a confirmatory test to improve test specificity is desirable.
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Using age-specific reference ranges and a PSA cutpoint below 4 ng/ml improved test specificity and sensitivity, respectively, but did not improve the overall accuracy of PSA testing.
Only the combination of LAM-positivity and fever (body temperature ≥ 37.5°C) at the enrolment visit was different in this respect: this criterion improved test specificity from 87.8 to 98.8% and reduced the sensitivity by about 50% (from 50.7% to 23.9%).
Changing the cut point to improve sensitivity or specificity simply compromised the other measure and therefore did not improve test performance.
We evaluated the use of alternative thresholds for Pap positivity (eg., LSIL, HSIL) to improve the test specificity, but found these to result in a significant reduction in test sensitivity (data not shown).
Using a 50-cell cutoff and including only patients with CMV symptoms and CD4<100, improved test accuracy: sensitivity, specificity, PPV, and NPV of 60, 91, 60, and 91%.
This exclusion improved the test specificity and resulted in the following parameters: AUC 0.887 (0.749–0.964) and optimal sensitivity at the criterion for MODY of <6.5 μg/ml 1,5-AG 85.7% (63.6 96.8%) and specificity 80.0% (56.3 94.1%).
Higher VPT cut points improved test sensitivity and lower cut points improved specificity.
Improved tests are urgently needed.
We show that combining the two imaging tests does improve sensitivity without significantly reducing test specificity.
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