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To select a proper diagnostic test, it is recommended that the most specific test be used to confirm (rule in) a diagnosis, and the most sensitive test be used to establish that a disease is unlikely (rule out). These rule-in and rule-out concepts can also be characterized by the likelihood ratio (LR). However, previous papers discussed only the case of binary tests and assumed test results already known.

Selecting diagnostic tests for ruling out or ruling in disease: the use of the Kullback-Leibler distance