Accuracy of clinicians and models for estimating the probability that a pulmonary nodule is malignant.
Accuracy of clinicians and models for estimating the probability that a pulmonary nodule is malignant.
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DOI：
10.1513/annalsats.201305-107oc
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发表时间：
2013-12-01
影响因子：
8.3
通讯作者：
Gould, Michael K
中科院分区：
文献类型：
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作者：
Balekian, Alex A;Silvestri, Gerard A;Gould, Michael K
依据：肺结节的治疗主要取决于恶性肿瘤的可能性。估计概率的模型已经开发和验证，但大多数临床医生依赖于judgment. Competitives：本研究的目的是比较两个预测models.METHODS的临床判断的准确性：医生参与者审查了5个临床小插曲，随机选择从一个较大的池35小插曲，所有基于实际患者的肺结节的已知最终诊断。影像包括临床信息和计算机断层扫描的代表性切片。临床医生估计每个小片段的恶性肿瘤概率。为了检验与模型的一致性，我们计算了组内相关系数（ICC）和Kappa统计量。为了检查准确性，我们比较了受试者工作特征曲线（AUC）下的面积。测量和主要结果：36名参与者完成了179个小插曲，其中47%描述了恶性结节患者。马约诊所模型的参与者和模型之间的一致性是公平的（ICC，0.37; 95%置信区间[CI]，0.23-0.50），退伍军人事务部模型的一致性是中等的（ICC，0.46; 95% CI，0.34-0.57）。参与者之间的准确性没有差异（AUC，0.70; 95% CI，0.62-0.77）和马约诊所模型（AUC，0.71; 95% CI，0.62-0.80; P = 0.90）或退伍军人事务部模型（AUC，0.72; 95% CI，0.64-0.80; P = 0.54）。在这项基于晕影的研究中，临床判断和模型似乎对肺结节表征具有相似的准确性，但判断和模型之间的一致性是适度的，这表明定性和定量方法可提供补充信息。
RATIONALE: Management of pulmonary nodules depends critically on the probability of malignancy. Models to estimate probability have been developed and validated, but most clinicians rely on judgment.OBJECTIVES: The aim of this study was to compare the accuracy of clinical judgment with that of two prediction models.METHODS: Physician participants reviewed up to five clinical vignettes, selected at random from a larger pool of 35 vignettes, all based on actual patients with lung nodules of known final diagnosis. Vignettes included clinical information and a representative slice from computed tomography. Clinicians estimated the probability of malignancy for each vignette. To examine agreement with models, we calculated intraclass correlation coefficients (ICC) and kappa statistics. To examine accuracy, we compared areas under the receiver operator characteristic curve (AUC).MEASUREMENTS AND MAIN RESULTS: Thirty-six participants completed 179 vignettes, 47% of which described patients with malignant nodules. Agreement between participants and models was fair for the Mayo Clinic model (ICC, 0.37; 95% confidence interval [CI], 0.23-0.50) and moderate for the Veterans Affairs model (ICC, 0.46; 95% CI, 0.34-0.57). There was no difference in accuracy between participants (AUC, 0.70; 95% CI, 0.62-0.77) and the Mayo Clinic model (AUC, 0.71; 95% CI, 0.62-0.80; P = 0.90) or the Veterans Affairs model (AUC, 0.72; 95% CI, 0.64-0.80; P = 0.54).CONCLUSIONS: In this vignette-based study, clinical judgment and models appeared to have similar accuracy for lung nodule characterization, but agreement between judgment and the models was modest, suggesting that qualitative and quantitative approaches may provide complementary information.