Prevalence of abnormalities influences cytologists' error rates in screening for cervical cancer.
Prevalence of abnormalities influences cytologists' error rates in screening for cervical cancer.
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DOI：
10.5858/arpa.2010-0739-oa
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发表时间：
2011-12
影响因子：
4.6
通讯作者：
Wolfe JM
中科院分区：
文献类型：
--
作者：
Evans KK;Tambouret RH;Evered A;Wilbur DC;Wolfe JM
医疗筛查任务往往很困难，目视搜索目标患病率低（发病率低）。在实验室条件下，当目标很少时，与目标常见时相比，非专家搜索者的假阳性结果减少，假阴性结果增加。这种普遍效应不是由于警惕失败或对目标不熟悉。确定流行效应是否可能是医学专家假阴性错误增加的一个来源。我们研究了两组参与宫颈癌筛查的细胞学家（波士顿，马萨诸塞州和南威尔士，英国）。细胞学家评估低（2%或5%）或高（50%）异常发生率的细胞显微照片。进行了两个版本的实验。来自马萨诸塞州波士顿的研究小组使用一个4分制的评定量表来判断结果是否正常。此外，来自南威尔士的小组定位了明显的异常。在这两组中，都有流行效应的证据。假阴性错误率为17%（高患病率），在马萨诸塞州波士顿组上升至30%（低患病率）。错误率为27%（高患病率），在南威尔士组上升到42%（低患病率）。（两组之间的比较没有意义，因为刺激集不同。）据我们所知，这些结果提供了第一个证据，表明即使有来自其专业领域的刺激，专家也不能免受流行的影响。流行率是人类观察者进行疾病筛查时要考虑的一个因素，对于后人类乳头瘤病毒疫苗时代基于细胞学的宫颈癌筛查具有重要意义，届时人群中高级别病变的流行率预计将下降。
Medical screening tasks are often difficult, visual searches with low target prevalence (low rates of disease). Under laboratory conditions, when targets are rare, nonexpert searchers show decreases in false-positive results and increases in false-negative results compared with results when targets are common. This prevalence effect is not due to vigilance failures or target unfamiliarity. To determine whether prevalence effects could be a source of elevated false-negative errors in medical experts. We studied 2 groups of cytologists involved in cervical cancer screening (Boston, Massachusetts, and South Wales, UK). Cytologists evaluated photomicrographs of cells at low (2% or 5%) or higher (50%) rates of abnormality prevalence. Two versions of the experiment were performed. The Boston, Massachusetts, group made decisions of normal or abnormal findings using a 4-point rating scale. Additionally, the group from South Wales localized apparent abnormalities. In both groups, there is evidence for prevalence effects. False-negative errors were 17% (higher prevalence), rising to 30% (low prevalence) in the Boston, Massachusetts, group. The error rate was 27% (higher prevalence), rising to 42% (low prevalence) in the South Wales group. (Comparisons between the 2 groups are not meaningful because the stimulus sets were different.) These results provide the first evidence, to our knowledge, that experts are not immune to the effects of prevalence even with stimuli from their domain of expertise. Prevalence is a factor to consider in screening for disease by human observers and has significant implications for cytology-based cervical cancer screening in the post–human papillomavirus vaccine era, when prevalence rates of high-grade lesions in the population are expected to decline.