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Although these methods don’t rely on a gold standard for comparison, they do depend on a number of important assumptions. Violation of these assumptions could render the resulting estimates invalid. Non-gold-standard methods for estimating sensitivity and specificity of diagnostic tests have been described in more detail by Hui and Walter ([#_ENREF_9 1980]), Staquet et al. ([#_ENREF_19 1981]) and Enøe et al. ([#_ENREF_4 2000]).