Accuracy of retinopathy of prematurity diagnosis by retinal fellows.
Accuracy of retinopathy of prematurity diagnosis by retinal fellows.
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DOI：
10.1097/iae.0b013e3181c9696a
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发表时间：
2010-06
期刊：
影响因子：
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通讯作者：
Chiang MF
中科院分区：
文献类型：
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作者：
Paul Chan RV;Williams SL;Yonekawa Y;Weissgold DJ;Lee TC;Chiang MF
目的：探讨视网膜研究员对早产儿视网膜病变（ROP）诊断的准确性。使用广角相机（RetCam-II; Clarity Medical Systems, Pleasanton， CA）从67名早产儿的248只眼睛中捕获804张视网膜图像的图集。图像被上传到一个研究网站，由一名儿科视网膜专家和七名视网膜研究员独立提供每只眼睛的诊断（无ROP、轻度ROP、2型ROP或需要治疗的ROP）。计算每个视网膜研究员的敏感性和特异性，并与儿科视网膜专家的诊断参考标准进行比较。同伴检测2型及更坏ROP的平均（范围）敏感性为0.751(0.512-0.953)，特异性为0.841（0.707-0.976）。检测需要治疗的ROP，平均（范围）敏感性为0.914(0.667 ~ 1.000)，特异性为0.871（0.678 ~ 0.987）。总的来说，研究员在检测ROP方面表现出很高的准确性。然而，3/7的患者诊断2型或更严重ROP的敏感性低于80%，2/7的患者诊断需要治疗的ROP的敏感性低于90%。这可能导致临床重要疾病的管理和治疗不足，并引起对经验不足的检查人员进行ROP筛查质量的潜在担忧。
To measure the accuracy of retinopathy of prematurity (ROP) diagnosis by retinal fellows. An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II; Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study website, from which an expert pediatric retinal specialist and seven retinal fellows independently provided a diagnosis (no ROP, mild ROP, type-2 ROP, or treatment-requiring ROP) for each eye. Sensitivity and specificity of each retinal fellow was calculated, compared to a reference standard of diagnosis by the expert pediatric retinal specialist. For detection of type-2 or worse ROP by fellows, mean (range) sensitivity was 0.751 (0.512–0.953) and specificity was 0.841 (0.707–0.976). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.914 (0.667–1.000) and specificity was 0.871 (0.678–0.987). In general, fellows demonstrated high accuracy for detecting ROP. However, 3/7 fellows achieved less than 80% sensitivity for diagnosis of type-2 or worse ROP, and 2/7 achieved less than 90% sensitivity for diagnosis of treatment-requiring ROP. This could lead to under-management and under-treatment of clinically significant disease, and raises potential concerns about the quality of ROP screening performed by less experienced examiners.