预先诊断对第二意见和病理学家观看行为的影响:乳腺病理学随机试验的结果
Kathleen F Kerr1, Megan M Eguchi2, Hannah Shucard1
1Department of Biostatistics, University of Washington, Seattle, WA, USA.
概括
以前的诊断显著影响乳腺病理学第二意见,影响诊断准确性和病理学家查看行为. 需要协议来确保独立的评估,并减轻病理诊断中的偏见.
科学领域:
- 病理学 病理学 病理学
- 医学诊断 医学诊断 医学诊断
- 医学中的认知偏见医学中的认知偏见
背景情况:
- 在病理学中,第二意见对于诊断准确性至关重要.
- 之前的诊断信息可能会引入认知偏见,可能会影响后续解释的独立性.
- 了解这些偏见对于完善诊断工作流程至关重要.
研究的目的:
- 研究先前诊断 (PD) 对病理学家在乳腺病理学中的第二意见的影响.
- 分析先前的诊断信息如何影响病理学家的解释行为,包括视觉注意力和变焦水平.
- 在第二意见程序中识别潜在的认知偏见,如定和确认偏见.
主要方法:
- 病理学家将数字乳腺活检病例解释为两个阶段.
- 第二阶段的解释被随机分配到接受先前诊断 (PD) 或没有PD.
- 记录了观看行为,包括变焦水平和关注关键区域.
- 患PD的严重程度与参与者的初始诊断相比有所不同.
主要成果:
- 病理学家在暴露于不那么严重的PD时,有71%的可能性更有可能给出较轻的诊断.
- 暴露于更严重的PD增加了更严重诊断的可能性,虽然不是显著的 (RR 1.27).
- 观看行为发生了转变:较不严重的PD导致更多关注关键区域;更严重的PD导致更高的变焦水平.
结论:
- 以前的诊断系统地影响了乳腺病理学的第二意见,破坏了评估独立性.
- 固定和确认偏差是显而易见的,表明PD暴露改变了解释过程.
- 对计算机辅助诊断工具和制定协议以确保客观的第二次意见存在影响.
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