Abstract
Objective
We define the prevalence threshold as the prevalence level below which a test’s positive
predictive value (PPV) declines most sharply relative to disease prevalence – and
thus the rate of false positive results/false discovery rate increases most rapidly.
The objective of this study is to determine the prevalence threshold of various screening
tests used in obstetrics and gynecology among low-risk women in modern clinical practice.
Methods
We searched Medline, EMBASE, Google Scholar, Scopus, ISI Web of Science, Cochrane
database, and PubMed to obtain the sensitivity and specificity estimates for the following
screening tests: 50 g-oral glucose tolerance test (GDM-50 g), non-invasive prenatal
testing (NIPT), combined first trimester screening (FTS), vagino-rectal swab for group
B streptococcus (GBS) in pregnancy, cervical cytology (Pap) and HPV testing, mammography
and manual breast exam, urinary PCR and cervical-vaginal swab testing for gonorrhoea
and chlamydia as well as AMH for the diagnosis of PCOS. We used these estimates to
calculate disease-specific prevalence thresholds, comparing them to the actual estimates
of disease prevalence.
Results
The prevalence thresholds and average estimates of disease prevalence (shown in brackets)
are as follows: GDM-50 g 31 % (6%), NIPT 7% (0.2 %), combined FTS 19.5 % (0.2 %),
GBS swab 18 % (15–45 %), Pap 21 % (0.2 %), HPV 27 % (0.2 %), mammography 25 % (12.5
%), breast exam 25 % (12.5 %), gonorrhoea -chlamydia 6–13 % (4.2–4.7 %), AMH for PCOS
32 % (10 %).
Conclusion
The prevalence thresholds of various screening tests used in obstetrics and gynecology
are well above the estimated disease prevalence. This implies that when undertaking
population-level screening a significant proportion of positive screening tests obtained
are likely false-positives. Attempts at individualizing pre-test probability when
undertaking population-level screening are needed in order to best interpret the results
of screening tests.
Keywords
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Article info
Publication history
Published online: February 18, 2021
Accepted:
February 16,
2021
Received in revised form:
February 11,
2021
Received:
December 3,
2020
Identification
Copyright
© 2021 Published by Elsevier B.V.
