Bayesian hierarchical latent class models for estimating diagnostic accuracy.

The diagnostic accuracy of a test or rater has a crucial impact on clinical decision making. The assessment of diagnostic accuracy for multiple tests or raters also merits much attention. A Bayesian hierarchical conditional independence latent class model for estimating sensitivities and specificities for a large group of tests or raters is proposed, which is applicable to both with-gold-standard and without-gold-standard situations. Through the hierarchical structure, not only are the sensitivities and specificities of individual tests estimated, but also the diagnostic performance of the whole group of tests. For a small group of tests or raters, the proposed model is further extended by introducing pairwise covariances between tests to improve the fitting and to allow for more modeling flexibility. Correlation residual analysis is applied to detect any significant covariance between multiple tests. Just Another Gibbs Sampler (JAGS) implementation is efficiently adopted for both models. Three real data sets from literature are analyzed to explicitly illustrate the proposed methods.