Evaluation of Diagnostic Tests Using Information Theory for Multi-Class Diagnostic Problems and its Application for the Detection of Occlusal Caries Lesions

Year 2014, Volume: 31 Issue: 3, 214 - 218, 01.07.2014

Umut Arslan Ergun Karaağaoğlu Gökhan Özkan Aydan Kanlı

Abstract

_Several methods are available to evaluate the performance of the tests when the purpose of the diagnostic test is to discriminate between two possible disease states. However multi-class diagnostic problems frequently appear in many areas of medical science. Hence, there is a need for methods which will enable us to characterize the accuracy of diagnostic tests when there are more than two possible disease states. Aims_ To show that two information theory measures, information content (IC) and proportional reduction in diagnostic uncertainty (PRDU), can be used for the evaluation of the performance of diagnostic tests for multi-class diagnostic problems that may appear in different areas of medical science. Study Design_ Diagnostic accuracy study. Methods_ Sixty freshly extracted permanent human molar and premolar teeth suspected to have occlusal caries lesions were selected for the study and were assessed by two experienced examiners. Each examiner performed two evaluations. Histological examination was used as the gold standard. The scores of the histological examination were defined as sound (n=11), enamel caries (n=22) and dentin caries (n=27). Diagnostic performance of i) visual inspection, ii) radiography, iii) laser fluorescence (LF) and iv) micro-computed tomography (M-CT) caries detection methods was evaluated by calculating IC and PRDU. Results_ Micro-computed tomography examination was the best method among the diagnostic techniques for the diagnosis of occlusal caries in terms of both IC and PRDU. M-CT examination supplied the maximum diagnostic information about the diagnosis of occlusal caries in the first (IC_ 1.056

Keywords

Diagnostic test, information content, occlusal caries, proportional reduction in diagnostic uncertainty

References

• 1. Thomas JA. Elements of information theory. 2nd ed. New York: John Wiley & Sons; 2006.
• 2. Asch DA, Patton PJ, Hershey JC. Knowing forthe sake of knowing:The value of prognostic information. Med Decis Making 1990;10:47-57. [CrossRef]
• 3. Klir GJ. Uncertainty and information. NewYork:John Wiley & Sons; 2006.
• 4. Benish WA. Mutual information as an index of diagnostic test performance. Methods Inf Med 2003;42:260-4.
• 5. Metz CE, Goodenough DJ, Rossmann K. Evaluation of receiver operating characteristic curve data in terms of information theory with applications in radiography. Radiology 1973;109:297-303. [CrossRef]
• 6. Mossman D, Somoza E. Diagnostic tests and information theory. J Neuropsychiatry Clin Neurosci 1992;4:95-8.
• 7. Kim JO. PRU Measures of association for contingency table analysis. Social Methods Res 1984;13:3-44. [CrossRef]
• 8. Golden LL, Brockett PL, Zimmer MR. An information theoretic approach for identifying shared information and asymmetric relationships among variables. Multivariate Behav Res 1990;25:479-502. [CrossRef]
• 9. Ismail AL, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al. The International Caries Detection and Assessment System (ICDAS): An integrated system for measuring dental caries. Dent Oral Epidemiol 2007;35:170-8. [CrossRef]
• 10. Extrand KR, Martignon S, Ricketts DJ, Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent 2007;32:225-35. [CrossRef]
• 11. Extrand KR, Ricketts DJ, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Res1997;32:225-235.
• 12. Lussi A, Hellwig E. Performance of a new laser fluorescence device for the detection of occlusal caries in vitro. J Dent 2006;34:467-71. [CrossRef]
• 13. Downer MC. Concurrent validity of an epidemiological diagnostic system for caries with the histological appearance of extracted teeth as validating criterion. Caries Res 1975;9:231-46. [CrossRef]
• 14. Nakas CT, Yiannoutsos CT. Ordered multiple-class ROC analysis with continious measurements. Stat Med 2004;23:3437-49. [CrossRef]
• 15. Somoza E, Mossman D. Neuropsychiatric decision making: Designing nonbinary diagnostic tests. J Neuropsychiatry Clin Neurosci 1991;3;197-200.
• 16. MossmanD.Three-wayROCs.Med Decis Making 1999;19:78-89.[CrossRef]
• 17. Ekstrand K, Qvist V, Thylstrup A. Light microscope study of the effect of probing in occlusal surfaces. Caries Res 1987;21:368-374. [CrossRef]
• 18. Sawle RF, Andlaw RJ. Has occlusal caries become more difficult to diagnose? Br Dent J 1988;164:209-11. [CrossRef]
• 19. Rodrigues JA, Hug I, Diniz MB, Lussi A. Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 2008;42:297-304. [CrossRef]
• 20. Ekstrand KR, Luna LE, Promisiero L, Cortes A, Cuevas S, Reyes JF, et al. The reliability and accuracy of two methods for proximal caries detection and depth on directly visible proximal surfaces: an in vitro study. Caries Res 2011;45:93-9. [CrossRef]
• 21. Neuhaus KW, Rodrigues JA, Hug I, Stich H, Lussi A. Performance of laser fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars. Clin Oral Investig 2011;15:635-41. [CrossRef]
• 22. Sridhar N, Tandon, Rao NA. Comparative evaluation of DIAGNOdent with visual and radiography for detection of occlusal caries: an in vitro study. Indian J Dent Res 2009;20:326-31. [CrossRef]
• 23. Rodrigues JA, Hug I, Diniz MB, Lussi A. Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 2008;42:297-304. [CrossRef]
• 24. White SC, Pharoah MJ. Oral Radiology Principles and interpretation. 6th ed. New Delhi: St. Louis Mosby; 2009.
• 25. Bader JD, Shugars DA, Bonito AJ. Systematic reviews of selected dental caries diagnosis and management methods. J Dent Educ 2001;65:960-8.
• 26. Kavvadia K, Lagouvardos P, Apostolopoulo D. Combined validity of DIAGNOdent and visual examination for in vitro detection of occlusal caries in primary molars. Lasers Med Sci 2012;27:313-9. [CrossRef]
• 27. Chu CH, Lo EC, You DS. Clinical diagnosis of fissure caries with conventional and laser-induced fluorescence techniques. Lasers Med Sci 2010;25:355-62. [CrossRef]
• 28. Kamburoğlu K, Kurt H, Kolsuz E, Öztaş B, Tatar İ, Çelik HH. Occlusal caries depth measurements obtained by five different imaging modalities. J Digit Imaging 2011;24:804-13. [CrossRef]
• 29. Mitropoulos P, Rahiotis C, Stamatakis H, Kakaboura A. Diagnostic performance of the visual caries classification system ICDAS II versus radiography and micro-computed tomography for proximal caries detection: an in vitro study. J Dent 2010;38:859-67. [CrossRef]
• 30. Soviero VM, Leal SC, Silva RC, Azevedo RB. Validity of MicroCT for in vitro detection of proximal c