Assessment of qualitative tests

For qualitative (2-class) tests, which provide binary (yes/no) information, the correctness of specimen classification remains the most important criterion for performance evaluation. However, a more informative picture emerges from the relationship between percentage of positive results and analyte concentration, which allows some inherent test characteristics to be derived (the positive/negative discrimination concentration and the "grey zone" around it). The information content of evaluation approaches is decidedly improved by the availability of numerical results (counts per minute, absorbance) in most situations of clinical interest. The concentration/response functions underlying the quality of individual tests may thus be derived and compared, and laboratory staff given a more objective criterion to judge individual performance. Examples are drawn from the authors' experience in running external quality assessment programs for tests for infectivity markers.