由医学生、住院医师和病理学家进行的计算机辅助肿瘤细胞分数(TCF)评估提高了观察者之间的一致性,同时突出了自动化偏差的风险。

IF 3.1 3区 医学 Q1 PATHOLOGY
Ana Leni Frei, Amjad Khan, Raphaël Oberson, Stefan Reinhard, Yara Banz, Frédérique Meeuwsen, Andrew Janowczyk, Rainer Grobholz, Heather E Dawson, Alessandro Lugli, Marius Ilié, Jeroen van der Laak, Inti Zlobec
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引用次数: 0

摘要

计算机辅助诊断(CAD)在组织病理学医学教育中增强学习成果的潜力是巨大的。然而,如果输出不准确,过度依赖CAD工具可能导致重大错误,例如自动化偏差。在这里,我们分析了用于肿瘤细胞分数(TCF)估计的CAD工具(称为TCFCAD)对组织病理学专业知识有限的医学生的影响,与病理学住院医师和执业病理学家相比。参与者是来自伯尔尼大学的三年级医学生(n = 18)、住院医师和来自欧洲分子病理学硕士(EMMP;按20年执业经验分层的执业病理学家63名(分别为28名和32名)。在有和没有TCFCAD辅助的情况下,每组评估10个结直肠癌感兴趣区域(ROI)。ground truth (GT)是通过每个ROI中所有肿瘤和非肿瘤细胞的费力计数来评估的。在TCFCAD辅助下,所有组的TCF评分变异性均有所降低。医学生TCF评分与GT值的标准差(SD)分别为9.09 ~ 4.95,EMMP为9.93 ~ 5.55,20年经验的病理医师为9.98 ~ 5.69和9.9 ~ 6.13。对于一张图像,尽管(1)工具输出不准确,(2)参与者在没有TCFCAD辅助的情况下的原始分数更接近GT值,但医学生和EMMP参与者的分数都倾向于TCFCAD的输出。这证实了医学生在所有roi中遵循该工具建议的趋势。对于有明显炎症浸润的肿瘤,所有组均从TCFCAD输出中获益最多。尽管TCFCAD在独立于专业经验的情况下改善了观察员间的协议,但过度依赖其输出存在明显的危险。在培训学生和病理学家使用CAD工具时,必须解决这一重要的偏见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Computer-aided tumor cell fraction (TCF) estimation by medical students, residents, and pathologists improves inter-observer agreement while highlighting the risk of automation bias.

The potential for computer-aided diagnostics (CAD) to augment learning outcomes for medical education in histopathology are vast. However, over-reliance in CAD tools could lead to important errors if the output is inaccurate, such as automation bias. Here, we analyze the influence of a CAD tool for tumor cell fraction (TCF) estimation, named TCFCAD, on medical students with limited histopathological expertise, compared to pathology residents and practicing pathologists. Participants were third-year medical students from the University of Bern (n = 18), residents and pathologists from the European Masters in Molecular Pathology (EMMP; n = 23), and 63 practicing pathologists stratified by < 20 or > 20 years of professional experience (n = 28 and 32, respectively). Each group evaluated 10 colorectal cancer regions of interest (ROI) with and without TCFCAD assistance. The ground truth (GT) was evaluated by a laborious count of all tumor and non-tumor cells per ROI. All groups demonstrated reduced variability in TCF scores with TCFCAD assistance. The standard deviation (SD) of the TCF scores compared to the GT values before and after TCFCAD assistance were 9.09 to 4.95 for medical students, 9.93 to 5.55 for EMMP, and 9.98 to 5.69 and 9.9 to 6.13 for pathologists with < 20 and > 20 years of experience. For one image, both medical students and EMMP participants' scores swayed to the TCFCAD's output despite (1) tool output being inaccurate and (2) participants' original scores without TCFCAD assistance being closer to the GT value. This confirmed a trend of medical students following the tool's recommendation across all ROIs. All groups benefitted most from TCFCAD output for a tumor with marked inflammatory infiltrates. Although TCFCAD improved interobserver agreement, independently of professional experience, there is a demonstrated danger in over-relying on its output. This important bias must be addressed when training students and pathologists on the use of CAD tools.

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来源期刊
Virchows Archiv
Virchows Archiv 医学-病理学
CiteScore
7.40
自引率
2.90%
发文量
204
审稿时长
4-8 weeks
期刊介绍: Manuscripts of original studies reinforcing the evidence base of modern diagnostic pathology, using immunocytochemical, molecular and ultrastructural techniques, will be welcomed. In addition, papers on critical evaluation of diagnostic criteria but also broadsheets and guidelines with a solid evidence base will be considered. Consideration will also be given to reports of work in other fields relevant to the understanding of human pathology as well as manuscripts on the application of new methods and techniques in pathology. Submission of purely experimental articles is discouraged but manuscripts on experimental work applicable to diagnostic pathology are welcomed. Biomarker studies are welcomed but need to abide by strict rules (e.g. REMARK) of adequate sample size and relevant marker choice. Single marker studies on limited patient series without validated application will as a rule not be considered. Case reports will only be considered when they provide substantial new information with an impact on understanding disease or diagnostic practice.
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