Precisely wrong? Urinary fractionated metanephrines and peer-based laboratory proficiency testing.

Hilden lists some of these limitations in his letter; another important one is its global interpretation, which does not translate well into clinical practice (1 ). The partial area under the ROC curve in the clinically relevant range of false-positive rates, or falsenegative rates, is a useful alternative measure of inherent diagnostic accuracy. Dr. Hilden advocates performance measures that incorporate the pretest probability of disease and the clinical benefit and loss of correct and incorrect diagnoses. These measures are extremely useful, but they are not measures of inherent test accuracy. Our recent review (2 ) focused on problems with the analysis of ROC curves, without critiquing issues of study design. I would encourage investigators to carefully consider the objectives of their study and use the most relevant measure of diagnostic test accuracy.