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Large-scale receiver operating characteristic (ROC) studies are expensive and time-consuming. If most of the difference in diagnostic accuracy occurs in a subset of subtle cases, considerable effort could be saved by restricting comparisons to this subset. We investigate the effect of subtle cases on diagnostic accuracy, the magnitude of error that can occur because of an imbalance of subtle cases in two groups, and the potential for sample size reductions if only subtle cases are used.

Imaging systems evaluation: effect of subtle cases on the design and analysis of receiver operating characteristic studies.