How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test
A. A. Nierenberg and A. R. Feinstein
Robert Wood Johnson Clinical Scholar Program, Yale University School of Medicine, New Haven, Conn.
To understand why the dexamethasone suppression test (DST) for the
diagnosis of depression became widely accepted and later rejected, we
reviewed the sequence of publications in the DST literature. To evaluate
the events, we developed and applied concepts of a five-phase process that
can be used to assess the clinical utility of diagnostic marker tests. The
review showed that when the DST was introduced into the clinical arena, the
initial and final two phases of testing (I, IV, and V) had not been
adequately conducted. When these phases of testing were suitably checked
many years later, the Phase I studies (exploring basic mechanics of test
procedures) showed that dexamethasone had variable bioavailability and that
the cortisol assay procedure was unreliable. The Phase IV and V studies
(examining test results in groups with suitably broad spectrums of cases
and controls) showed that the test did not differentiate depression from
most pertinent comorbid conditions. Beyond application to the specific
problems of the DST, the proposed five phases of development and evaluation
for diagnostic marker tests can be used to plan suitable research and avoid
similar problems in the future.
The evaluation of genetic tests
Zimmern and Kroese
J Public Health (Oxf) 2007;29:246-250.
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Cytochrome P450 genotyping and antidepressants
Perlis
BMJ 2007;334:759-759.
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Challenges in Systematic Reviews of Diagnostic Technologies
Tatsioni et al.
ANN INTERN MED 2005;142:1048-1055.
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The quality of reporting of diagnostic accuracy studies published in ophthalmic journals
Siddiqui et al.
Br. J. Ophthalmol. 2005;89:261-265.
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Biomarkers: From Bedside to Bench and Back Again
Pollock
AJGP 2002;10:644-645.
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Neuroimaging Profiles and the Differential Therapies of Depression
Thase
Arch Gen Psychiatry 2001;58:651-653.
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Decreased Cortisol Levels in Adolescent Girls With Conduct Disorder
Pajer et al.
Arch Gen Psychiatry 2001;58:297-302.
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Evidence-based Laboratory Medicine: Supporting Decision-Making
Price
Clin. Chem. 2000;46:1041-1050.
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Pleural Fluid pH as a Predictor of Pleurodesis Failure* : Analysis of Primary Data
Heffner et al.
Chest 2000;117:87-95.
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Classic, Abbreviated, and Modified Light’s Criteria : The End of the Story?
Porcel et al.
Chest 1999;116:1833-1836.
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To test or not to test?
Holloway and Feasby
Neurology 1999;53:1905-1905.
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Bayesian Approaches to Meta-analysi of ROC Curves
Hellmich et al.
Med Decis Making 1999;19:252-264.
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Clinical Epidemiological Quality in Molecular Genetic Research: The Need for Methodological Standards
Bogardus et al.
JAMA 1999;281:1919-1926.
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Screening Tests for Alcohol Use Disorders
Volk et al.
ANN INTERN MED 1999;130:779-780.
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