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Initially identified in 1978[1], spectrum bias refers to evaluating the ability of a diagnostic test in a biased group of patients which leads to an overestimation of the sensitivity and specificity of the test.[1][2] Examples are initial overestimates of the sensitivity and specificity of the carcinoembryonic antigen[3] and urinary dipstick tests.[4]

The inflated results can occur when the diagnostic test is compared in a healthy population versus a population with advanced disease.

If properly analyzed, recognition of heterogeneity of subgroups can lead to insights about the test's performance in varying populations.[5]


  1. ^ a b Ransohoff DF, Feinstein AR (1978). "Problems of spectrum and bias in evaluating the efficacy of diagnostic tests". N. Engl. J. Med. 299 (17): 926–30. PMID 692598.  
  2. ^ Goehring C, Perrier A, Morabia A (2004). "Spectrum bias: a quantitative and graphical analysis of the variability of medical diagnostic test performance". Statistics in medicine 23 (1): 125–35. doi:10.1002/sim.1591. PMID 14695644.  
  3. ^ Fletcher RH (1986). "Carcinoembryonic antigen". Ann. Intern. Med. 104 (1): 66–73. PMID 3510056.  
  4. ^ Lachs MS, Nachamkin I, Edelstein PH, Goldman J, Feinstein AR, Schwartz JS (1992). "Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection". Ann. Intern. Med. 117 (2): 135–40. PMID 1605428.  
  5. ^ Mulherin SA, Miller WC (2002). "Spectrum bias or spectrum effect? Subgroup variation in diagnostic test evaluation". Ann. Intern. Med. 137 (7): 598–602. PMID 12353947.  

See also


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