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High Quality Content by WIKIPEDIA articles! Initially identified in 1978, spectrum bias refers to the phenomenon that the performance of a diagnostic test may change between different clincial settings owing to changes in the patient case-mix thereby affecting the transferability of study results in clinical practice. In the statistical sense it is not truly a bias and has led some authors to refer to the effect(s) as 'spectrum effects', whilst others maintain it is bias if the true performance of the test differs from that which is 'expected'. Usually the performance of a diagnostic test is measured in terms of its sensitivity and specificity and it is changes in these that are considered when referring to spectrum bias. However, other performance measures such as the likelihood ratios may also be affected by spectrum bias.