Use of "Diagnostic Yield" in Imaging Research Reports: Results from Articles Published in Two General Radiology Journals

Abstract

Objective: "Diagnostic yield," also referred to as the detection rate, is a parameter positioned between diagnostic accuracy and diagnosis-related patient outcomes in research studies that assess diagnostic tests. Unfamiliarity with the term may lead to incorrect usage and delivery of information. Herein, we evaluate the level of proper use of the term "diagnostic yield" and its related parameters in articles published in Radiology and Korean Journal of Radiology (KJR).

Materials and methods: Potentially relevant articles published since 2012 in these journals were identified using MEDLINE and PubMed Central databases. The initial search yielded 239 articles. We evaluated whether the correct definition and study setting of "diagnostic yield" or "detection rate" were used and whether the articles also reported companion parameters for false-positive results. We calculated the proportion of articles that correctly used these parameters and evaluated whether the proportion increased with time (2012-2016 vs. 2017-2022).

Results: Among 39 eligible articles (19 from Radiology and 20 from KJR), 17 (43.6%; 11 from Radiology and 6 from KJR) correctly defined "diagnostic yield" or "detection rate." The remaining 22 articles used "diagnostic yield" or "detection rate" with incorrect meanings such as "diagnostic performance" or "sensitivity." The proportion of correctly used diagnostic terms was higher in the studies published in Radiology than in those published in KJR (57.9% vs. 30.0%). The proportion improved with time in Radiology (33.3% vs. 80.0%), whereas no improvement was observed in KJR over time (33.3% vs. 27.3%). The proportion of studies reporting companion parameters was similar between journals (72.7% vs. 66.7%), and no considerable improvement was observed over time.

Conclusion: Overall, a minority of articles accurately used "diagnostic yield" or "detection rate." Incorrect usage of the terms was more frequent without improvement over time in KJR than in Radiology. Therefore, improvements are required in the use and reporting of these parameters.

Keywords: Detection rate; Diagnostic yield; False referral rate.

Fig. 1. Schematic diagram of a study setting in which diagnostic yield (or detection rate) and false referral rate are used and the contingency table reconstructed from the study setting.

As illustrated in the figure, diagnostic yield and false referral rate can be obtained even if reference standard information is not available for test-negative patients, which often occurs in screening test research. FN = false-negative, FP = false-positive, TN = true-negative, TP = true-positive

Fig. 2. Flowchart showing the article selection process.

Fig. 3. Summary charts of the included articles according to (A) study setting, (B) imaging purpose, (C) imaging target, and (D) imaging modality.

“Others” in (B) include screening of Crohn’s disease recurrence, detection of the pyramidal lobe, and detection of the epileptogenic focus.

Fig. 4. Study methods of diagnostic accuracy articles in which “diagnostic yield” and “detection rate” were misused (n = 22 studies).

“Diagnostic yield” was used as diagnostic performance or sensitivity, and “detection rate,” as sensitivity in all these studies. A. Only disease-positive cohorts were recruited; thus, only sensitivity could be calculated (n = 6). B. A specific imaging modality was used as a reference standard, and the performance of index imaging study was evaluated (in a mainly per-lesion analysis) (n = 9). C. Classic diagnostic cohort study in which all individuals with positive and negative test results underwent a gold-standard confirmatory test (n = 5). D. Case-control study (n = 2). FN = false-negative, FP = false-positive, TN = true-negative, TP = true-positive