Problems and solutions in the interpretation of diagnostic tests

The interpretation of diagnostic tests has had a remarkable progress in recent years with a tendency towards a more clinical and patient-oriented perspective. Here we emphasize the limitations of using the dichotomy positive/negative testing or cut-off points for normality in many of our medical decisions. We also introduce alternative methods to interpret diagnostic tests, specially in unusual circumstances, i.e. in the development of new diagnostic tests that may be better than the accepted gold standard or when there is no gold standard. Finally we analyze the different interpretations of false negative results that may modify the interpretation of subsequent testing in a patient.