An application of multinomial logistic regression to estimating performance of a multiple-screening test with incomplete verification

Abstract

The paper describes a method of estimating the performance of a multiple-screening test where those who test negatively do not have their true disease status determined. The methodology is motivated by a data set on 49927 subjects who were given K=6 binary tests for bowel cancer. A complicating factor is that individuals may have polyps in the bowel, a condition that the screening test is not designed to detect but which may be worth diagnosing. The methodology is based on a multinomial logit model for Pr(S|R6), the probability distribution of patient status S (healthy, polyps or diseased) conditional on the results R6 from six binary tests. An advantage of the methodology described is that ..