Article ; Online: Estimating the Irreducible Uncertainty in Visual Diagnosis: Statistical Modeling of Skill Using Response Models.
Medical decision making : an international journal of the Society for Medical Decision Making
2023 Volume 43, Issue 6, Page(s) 680–691
Abstract: Background: For the representative problem of prostate cancer grading, we sought to simultaneously model both the continuous nature of the case spectrum and the decision thresholds of individual pathologists, allowing quantitative comparison of how they ...
| Abstract | Background: For the representative problem of prostate cancer grading, we sought to simultaneously model both the continuous nature of the case spectrum and the decision thresholds of individual pathologists, allowing quantitative comparison of how they handle cases at the borderline between diagnostic categories. Methods: Experts and pathology residents each rated a standardized set of prostate cancer histopathological images on the International Society of Urological Pathologists (ISUP) scale used in clinical practice. They diagnosed 50 histologic cases with a range of malignancy, including intermediate cases in which clear distinction was difficult. We report a statistical model showing the degree to which each individual participant can separate the cases along the latent decision spectrum. Results: The slides were rated by 36 physicians in total: 23 ISUP pathologists and 13 residents. As anticipated, the cases showed a full continuous range of diagnostic severity. Cases ranged along a logit scale consistent with the consensus rating (Consensus ISUP 1: mean -0.93 [95% confidence interval {CI} -1.10 to -0.78], ISUP 2: -0.19 logits [-0.27 to -0.12]; ISUP 3: 0.56 logits [0.06-1.06]; ISUP 4 1.24 logits [1.10-1.38]; ISUP 5: 1.92 [1.80-2.04]). The best raters were able to meaningfully discriminate between all 5 ISUP categories, showing intercategory thresholds that were quantifiably precise and meaningful. Conclusions: We present a method that allows simultaneous quantification of both the confusability of a particular case and the skill with which raters can distinguish the cases. Implications: The technique generalizes beyond the current example to other clinical situations in which a diagnostician must impose an ordinal rating on a biological spectrum. Highlights: Question: |
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| MeSH term(s) | Male ; Humans ; Neoplasm Grading ; Uncertainty ; Prostatic Neoplasms/diagnosis ; Prostatic Neoplasms/pathology ; Models, Statistical ; Pathologists |
| Language | English |
| Publishing date | 2023-07-03 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 604497-9 |
| ISSN | 1552-681X ; 0272-989X |
| ISSN (online) | 1552-681X |
| ISSN | 0272-989X |
| DOI | 10.1177/0272989X231162095 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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