Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images.
Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images.
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DOI：
10.1016/j.jbi.2017.01.004
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发表时间：
2017-02
影响因子：
4.5
通讯作者：
Elmore JG
中科院分区：
文献类型：
--
作者：
Brunyé TT;Mercan E;Weaver DL;Elmore JG
数字整体切片成像是病理学中越来越常见的媒介，可应用于教育、远程医疗和提供第二意见。它还使得有可能在病理学家审查病例时使用眼球跟踪装置来探索组织的组织病理学特征的动态视觉检查和解释。使用整个幻灯片的图像，本研究探讨了如何病理学家的诊断是固定的情况下的因素，他们以前的临床经验，他们的模式的视觉检查的影响。参与的病理学家解释了两个测试集之一，每个测试集包含12个乳腺活检标本的数字全载玻片图像。根据专家共识，病例代表了四种诊断类别：良性无乳腺癌、乳腺癌、导管原位癌（DCIS）和浸润性癌。每个病例包括一个或多个先前确定为具有关键诊断重要性的感兴趣区域（ROI）。在病理学家解释期间，我们跟踪眼球运动、查看器工具行为（缩放、平移）和解释时间。使用逻辑回归和线性回归建立模型，采用广义估计方程，测试病理学家、病例和视觉解释行为水平的变量是否会独立和/或交互地预测诊断准确性和效率。诊断的准确性随着病例共识诊断的功能而变化，复制了早期的研究。正如预期的那样，良性病例往往会引起假阳性，而乳腺癌、DCIS和浸润性病例往往会引起假阴性。病理学家的经验水平、病例共识诊断、病例难度、眼睛注视持续时间以及病理学家的眼睛在诊断ROI内与诊断ROI外注视的程度，都独立或交互地预测诊断准确性。更高的缩放行为预测了过度解释良性和乳腺癌病例的趋势，但不是DCIS病例。效率没有预测病理学家或视觉搜索水平的变量。研究结果为医学解释过程提供了新的见解，并展示了病理学家和指导诊断决策的病例之间的复杂相互作用。培训，临床实践和计算机辅助决策辅助工具的影响被认为是。
Digital whole slide imaging is an increasingly common medium in pathology, with application to education, telemedicine, and rendering second opinions. It has also made it possible to use eye tracking devices to explore the dynamic visual inspection and interpretation of histopathological features of tissue while pathologists review cases. Using whole slide images, the present study examined how a pathologist’s diagnosis is influenced by fixed case-level factors, their prior clinical experience, and their patterns of visual inspection. Participating pathologists interpreted one of two test sets, each containing 12 digital whole slide images of breast biopsy specimens. Cases represented four diagnostic categories as determined via expert consensus: benign without atypia, atypia, ductal carcinoma in situ (DCIS), and invasive cancer. Each case included one or more regions of interest (ROIs) previously determined as of critical diagnostic importance. During pathologist interpretation we tracked eye movements, viewer tool behavior (zooming, panning), and interpretation time. Models were built using logistic and linear regression with generalized estimating equations, testing whether variables at the level of the pathologists, cases, and visual interpretive behavior would independently and/or interactively predict diagnostic accuracy and efficiency. Diagnostic accuracy varied as a function of case consensus diagnosis, replicating earlier research. As would be expected, benign cases tended to elicit false positives, and atypia, DCIS, and invasive cases tended to elicit false negatives. Pathologist experience levels, case consensus diagnosis, case difficulty, eye fixation durations, and the extent to which pathologists’ eyes fixated within versus outside of diagnostic ROIs, all independently or interactively predicted diagnostic accuracy. Higher zooming behavior predicted a tendency to over-interpret benign and atypia cases, but not DCIS cases. Efficiency was not predicted by pathologist- or visual search-level variables. Results provide new insights into the medical interpretive process and demonstrate the complex interactions between pathologists and cases that guide diagnostic decision-making. Implications for training, clinical practice, and computer-aided decision aids are considered.