Gold Standard Ambiguity
Sometimes "Gold Standard test" refers to the best performing test available. In these cases, there is no other criterion against which it can be compared and it is equivalent to a definition. When referring to this meaning, gold standard tests are normally not performed at all. This is because the "gold standard" test may be difficult to perform or may be impossible to perform on a living person (i.e. the test is performed as part of an autopsy or may take too long for the results of the test to be available to be clinically useful).
Other times, "Gold standard" does not refer to the best performing test available, but the best available under reasonable conditions. For example, in this sense, a MRI is the gold standard for brain tumour diagnosis, though it is not as good as a biopsy. In this case the sensitivity and specifity of the gold standard are not 100% and it is said to be an "imperfect gold standard" or "Alloyed gold standard"
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