Gold standard for the comparison of the diagnostic accuracy of panoramic images for approximal caries detection

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Free AccessLetter to the editorGold standard for the comparison of the diagnostic accuracy of panoramic images for approximal caries detectionA WenzelA WenzelDepartment of Oral Radiology, School of Dentistry, Aarhus University, Denmark; E-mail: Search for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/dmfr/18326926SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutDentomaxillofacial Radiology (2009) 38, 245. doi: 10.1259/dmfr/18326926The authors of the research article titled “A comparison of the diagnostic accuracy of bitewing, periapical, unfiltered and filtered digital panoramic images for approximal caries detection in posterior teeth” published in Dentomaxillofacial Radiology 2007; 37: 441–4421 claim that a particular emboss filter for panoramic images has a higher diagnostic value than original images for detection of caries lesions. The authors of this study use a “consensus of the three observers” as an expression for the true state of the disease (a caries lesion). In fact, no data are available for the true state of the disease in this study. It is therefore unfortunate that the data are treated by receiver operating characteristics (ROC) analysis (which demands that a solid gold standard is available) and that the term “diagnostic accuracy” is used.Three criteria should be fulfilled for a method to provide a worthy gold standard:it should be established by a method that is itself precise, i.e. reproducibleit should reflect the pathoanatomical appearance of the diseaseit should be established independently of the diagnostic method under evaluation.2The three-observer-consensus-truth does not fulfill any of these criteria.It has moreover been shown that not only will ROC areas become extremely large (around 0.9) when an observer is also the gold standard (logically, since the same mind that produces the test results produces the reference results against which the test is held), but also the mutual accuracy among the modalities tested is different when a solid gold standard and an observer-consensus-standard is applied. The results from a study with the latter design can therefore not be trusted, neither regarding the diagnostic accuracy of the modalities, nor the mutual performance among the modalities.3, 4 It only muddles our findings. References 1 Akarslan ZZ, Akdevelioglu M, Güngör K, Erten H. A comparison of the diagnostic accuracy of bitewing, periapical, unfiltered and filtered digital panoramic images for approximal caries detection in posterior teeth. Dentomaxillofac Radiol 2008;37:458–463. Link ISI, Google Scholar2 Wenzel A, Hintze H. The choice of gold standard for evaluating tests for caries diagnosis. Dentomaxillofac Radiol 1999;28:132–136. Crossref Medline ISI, Google Scholar3 Wenzel A, Hintze H. Comparison of microscopy and radiography as gold standards in radiographic caries diagnosis. Dentomaxillofac Radiol 1999;28:182–185. Link ISI, Google Scholar4 Hintze H, Wenzel A. Influence of the validation method on diagnostic accuracy for caries. A comparison of six digital and two conventional radiographic systems. Dentomaxillofac Radiol 2002;31:44–49. Link ISI, Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byROLE OF ARTIFICIAL INTELLIGENCE APPLICATIONS IN DENTOMAXILLOFACIAL RADIOLOGY: PART 124 August 2022 | Selcuk Dental JournalRadiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systemsAnn Wenzel4 March 2021 | Dentomaxillofacial Radiology, Vol. 50, No. 5Caries20 February 2013Reply to the above commentary on the Letter to the Editor entitled “Gold standard for the comparison of the diagnostic accuracy of panoramic images for approximal caries detection” published in Dentomaxillofacial Radiology (2009;38:245)A Wenzel29 May 2014 | Dentomaxillofacial Radiology, Vol. 38, No. 7 Volume 38, Issue 4May 2009Pages: 187-246 © The British Institute of Radiology History Published onlineJanuary 28,2014 Metrics Download PDF