Should we believe the legend of fixed sensitivity? The Diagnostics Collaboration [oral presentation]

Introduction Empirical evidence has shown how the overall low methodological rigor of published diagnostic test accuracy studies alters estimates of sensitivity and specificity.[1] Features related to the study population, setting or test protocol typically impact on estimates of diagnostic test accuracy as well.[2] Although potential sources of bias and variation are well established, an international group of experts continues to notice an erroneous but widespread myth that estimates of sensitivity and specificity are fixed properties. Objective To boost the knowledge and correct use of estimates of diagnostic test accuracy and to increase the understanding of studies evaluating diagnostic, prognostic, or predictive medical tests in general. Methods Setting up a not-for-profit international collaboration open to passionate persons that either develop, evaluate, approve, use, interpret, or undergo medical tests. Organising in-person and remote meetings to identify main issues to be improved in the field of medical testing and to jointly develop a roadmap on actions to be undertaken to demystify common misconceptions using low-cost methods while obtaining optimal scientific, societal, and economic impacts. Results In October 2023 an international group of methodologists, clinicians, philosophers, and biostatisticians gathered in Rotterdam the Netherlands to discuss myths around medical tests, their impact, and their origin. During a two-day meeting in June 2024, part of this group met in Exeter (UK), with young investigators joining remotely. We discussed how misconceptions can lead to wrongly designed diagnostic test accuracy studies, erroneous interpretation of study findings and even inadequate decisions to use or reimburse medical tests for certain groups of individuals. The Table describes the output of the Exeter meetings for one of the myths to be busted with a selection of actions to be taken. The group, which was coined the Diagnostics Collaboration, recorded about 10 videos already, which are currently being prepped for publication. URL links to these videos will be shared at the SISMEC congress. [Table omitted from this abstract] Conclusions There are important misconceptions about the use, evaluation, and interpretation of medical tests, including the myth that estimates of sensitivity and specificity are fixed. Downstream consequences of such misconceptions can lead to research waste and suboptimal or inadequate testing strategies, which may impact on treatment decisions and health related outcomes. An international group of dedicated experts has joint efforts to reach a wide audience and boost their knowledge on medical tests, with the target to positively impact on the evaluation of medical test and all related downstream consequences.