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Gold-standard methods

Gold standard methods have the advantage of using a known disease status as the reference test. This allows for relatively simple calculations to estimate sensitivity and specificity of the test being evaluated, using a simple two-by-two cross-tabulation of the test against disease status. However, for many conditions a gold-standard test either does not exist or is prohibitively expensive to use (for example may require slaughter and detailed examination and testing of multiple tissues for a definitive result). In such cases the best available test is often used as if it were a gold standard, resulting in biased estimates of sensitivity and specificity. Alternatively, it may only be possible to use a small sample size due to financial limitations or the nature of the disease, resulting in imprecise estimates.