Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 3;23(4):195-198.
doi: 10.4103/tjem.tjem_182_23. eCollection 2023 Oct-Dec.

Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value

Şeref Kerem Çorbacıoğlu  1 , Gökhan Aksel  2
Affiliations

Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value

Şeref Kerem Çorbacıoğlu et al. Turk J Emerg Med. .

Abstract

This review article provides a concise guide to interpreting receiver operating characteristic (ROC) curves and area under the curve (AUC) values in diagnostic accuracy studies. ROC analysis is a powerful tool for assessing the diagnostic performance of index tests, which are tests that are used to diagnose a disease or condition. The AUC value is a summary metric of the ROC curve that reflects the test's ability to distinguish between diseased and nondiseased individuals. AUC values range from 0.5 to 1.0, with a value of 0.5 indicating that the test is no better than chance at distinguishing between diseased and nondiseased individuals. A value of 1.0 indicates perfect discrimination. AUC values above 0.80 are generally consideredclinically useful, while values below 0.80 are considered of limited clinical utility. When interpreting AUC values, it is important to consider the 95% confidence interval. The confidence interval reflects the uncertainty around the AUC value. A narrow confidence interval indicates that the AUC value is likely accurate, while a wide confidence interval indicates that the AUC value is less reliable. ROC analysis can also be used to identify the optimal cutoff value for an index test. The optimal cutoff value is the value that maximizes the test's sensitivity and specificity. The Youden index can be used to identify the optimal cutoff value. This review article provides a concise guide to interpreting ROC curves and AUC values in diagnostic accuracy studies. By understanding these metrics, clinicians can make informed decisions about the use of index tests in clinical practice.

Keywords: Area under the curve; diagnostic study; receiver operating characteristic analysis; receiver operating characteristic curve.

PubMed Disclaimer

Conflict of interest statement

None Declared.

Figures

Figure 1
Figure 1
Two different BNP distribution graphs of the subjects groups with and without heart failure. TN: true negative, TP: true positive, FN: false negative, FP: false positive (a) An ideal diagnostic test would yield sensitivity and specificity of 100%, resulting in non-overlapping BNP distribution graphs for individuals with and without heart failure. (b) real-world scenarios tend to involve overlapping distributions; sensitivity and specificity values are not 100%
Figure 2
Figure 2
Receiver Operating Characteristic (ROC) Curve
See this image and copyright information in PMC

References

    1. Knottnerus JA, Buntinx F. 2nd ed. Singapore: Wiley-Blackwell BMJ Books; 2009. The Evidence Base of Clinical Diagnosis: Theory and Methods of Diagnostic Research.
    1. Guyatt G. 3rd ed. New York: McGraw-Hill Education; 2015. Users’Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice.
    1. Akobeng AK. Understanding diagnostic tests 1: Sensitivity, specificity and predictive values. Acta Paediatr. 2007;96:338–41. - PubMed
    1. Akobeng AK. Understanding diagnostic tests 2: Likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatr. 2007;96:487–91. - PubMed
    1. Nahm FS. Receiver operating characteristic curve: Overview and practical use for clinicians. Korean J Anesthesiol. 2022;75:25–36. - PMC - PubMed