Receiver operating characteristic curve in diagnostic test assessment

The performance of a diagnostic test in the case of a binary predictor can be evaluated using the measures of sensitivity and specificity. However, in many instances, we encounter predictors that are measured on a continuous or ordinal scale. In such cases, it is desirable to assess performance of a diagnostic test over the range of possible cutpoints for the predictor variable. This is achieved by a receiver operating characteristic (ROC) curve that includes all the possible decision thresholds from a diagnostic test result. In this brief report, we discuss the salient features of the ROC curve, as well as discuss and interpret the area under the ROC curve, and its utility in comparing two different tests or predictor variables of interest.