The classification accuracy of a continuous marker is typically evaluated with the Receiver Operating Characteristic Curve. In this paper, we study an alternative conceptual framework, the "percentile value". In particular the controls only provide a reference distribution to standardize the marker. The analysis proceeds by analyzing the standardized marker only in cases. The approach is shown to be equivalent to ROC analysis. Advantages are that it provides a framework more familiar to biostatisticians and it opens up avenues for new statistical techniques in biomarker evaluation. We develop several new procedures based on this framework for comparing biomarkers and for comparing biomarker performance in different populations. We develop methods that adjust such comparisons for covariates. The methods are illustrated on data from two cancer biomarker studies.



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