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Ultrasound Experience Substantially Impacts on Diagnostic Performance and Confidence when Adnexal Masses Are Classified Using Pattern Recognition

Van Holsbeke, Caroline; Daemen, Anneleen; Yazbek, Joseph; Holland, Tom K.; Bourne, Tom; Mesens, Tinne; Lannoo, Lore; Boes, Anne-Sophie; Joos, Annelies and Van De Vijver, Arne, et al. (2010) In Gynecologic and Obstetric Investigation 69(3). p.160-168
Abstract
Aim: To determine how accurately and confidently examiners with different levels of ultrasound experience can classify adnexal masses as benign or malignant and suggest a specific histological diagnosis when evaluating ultrasound images using pattern recognition. Methods: Ultrasound images of selected adnexal masses were evaluated by 3 expert sonologists, 2 senior and 4 junior trainees. They were instructed to classify the masses using pattern recognition as benign or malignant, to state the level of confidence with which this classification was made and to suggest a specific histological diagnosis. Sensitivity, specificity, accuracy and positive and negative likelihood ratios (LR+ and LR-) with regard to malignancy were calculated. The... (More)
Aim: To determine how accurately and confidently examiners with different levels of ultrasound experience can classify adnexal masses as benign or malignant and suggest a specific histological diagnosis when evaluating ultrasound images using pattern recognition. Methods: Ultrasound images of selected adnexal masses were evaluated by 3 expert sonologists, 2 senior and 4 junior trainees. They were instructed to classify the masses using pattern recognition as benign or malignant, to state the level of confidence with which this classification was made and to suggest a specific histological diagnosis. Sensitivity, specificity, accuracy and positive and negative likelihood ratios (LR+ and LR-) with regard to malignancy were calculated. The area under the receiver operating characteristic curve (AUC) of pattern recognition was calculated by using six levels of diagnostic confidence. Results: 166 masses were examined, of which 42% were malignant. Sensitivity with regard to malignancy ranged from 80 to 86% for the experts, was 70 and 84% for the 2 senior trainees and ranged from 70 to 86% for the junior trainees. The specificity of the experts ranged from 79 to 91%, was 77 and 89% for the senior trainees and ranged from 59 to 83% for the junior trainees. The experts were uncertain about their diagnosis in 4-13% of the cases, the senior trainees in 15-20% and the junior trainees in 67-100% of the cases. The AUCs ranged from 0.861 to 0.922 for the experts, were 0.842 and 0.855 for the senior trainees, and ranged from 0.726 to 0.795 for the junior trainees. The experts suggested a correct specific histological diagnosis in 69-77% of the cases. All 6 trainees did so significantly less often (22-42% of the cases). Conclusion: Expert sonologists can accurately classify adnexal masses as benign or malignant and can successfully predict the specific histological diagnosis in many cases. Whilst less experienced operators perform reasonably well when predicting the benign or malignant nature of the mass, they do so with a very low level of diagnostic confidence and are unable to state the likely histology of a mass in most cases. Copyright (C) 2009 S. Karger AG, Basel (Less)
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keywords
Pattern recognition, Subjective impression, Ovarian tumors, Ultrasound experience, Diagnostic confidence, Statistical models, Risk of malignancy
in
Gynecologic and Obstetric Investigation
volume
69
issue
3
pages
160 - 168
publisher
Karger
external identifiers
  • wos:000273553000004
  • scopus:72049091811
ISSN
1423-002X
DOI
10.1159/000265012
language
English
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yes
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3d7fca4e-fe87-49ef-b2b3-16229a274f66 (old id 1547498)
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2010-02-23 13:37:44
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2018-05-29 09:18:26
@article{3d7fca4e-fe87-49ef-b2b3-16229a274f66,
  abstract     = {Aim: To determine how accurately and confidently examiners with different levels of ultrasound experience can classify adnexal masses as benign or malignant and suggest a specific histological diagnosis when evaluating ultrasound images using pattern recognition. Methods: Ultrasound images of selected adnexal masses were evaluated by 3 expert sonologists, 2 senior and 4 junior trainees. They were instructed to classify the masses using pattern recognition as benign or malignant, to state the level of confidence with which this classification was made and to suggest a specific histological diagnosis. Sensitivity, specificity, accuracy and positive and negative likelihood ratios (LR+ and LR-) with regard to malignancy were calculated. The area under the receiver operating characteristic curve (AUC) of pattern recognition was calculated by using six levels of diagnostic confidence. Results: 166 masses were examined, of which 42% were malignant. Sensitivity with regard to malignancy ranged from 80 to 86% for the experts, was 70 and 84% for the 2 senior trainees and ranged from 70 to 86% for the junior trainees. The specificity of the experts ranged from 79 to 91%, was 77 and 89% for the senior trainees and ranged from 59 to 83% for the junior trainees. The experts were uncertain about their diagnosis in 4-13% of the cases, the senior trainees in 15-20% and the junior trainees in 67-100% of the cases. The AUCs ranged from 0.861 to 0.922 for the experts, were 0.842 and 0.855 for the senior trainees, and ranged from 0.726 to 0.795 for the junior trainees. The experts suggested a correct specific histological diagnosis in 69-77% of the cases. All 6 trainees did so significantly less often (22-42% of the cases). Conclusion: Expert sonologists can accurately classify adnexal masses as benign or malignant and can successfully predict the specific histological diagnosis in many cases. Whilst less experienced operators perform reasonably well when predicting the benign or malignant nature of the mass, they do so with a very low level of diagnostic confidence and are unable to state the likely histology of a mass in most cases. Copyright (C) 2009 S. Karger AG, Basel},
  author       = {Van Holsbeke, Caroline and Daemen, Anneleen and Yazbek, Joseph and Holland, Tom K. and Bourne, Tom and Mesens, Tinne and Lannoo, Lore and Boes, Anne-Sophie and Joos, Annelies and Van De Vijver, Arne and Roggen, Nele and de Moor, Bart and de Jonge, Eric and Testa, Antonia C. and Valentin, Lil and Jurkovic, Davor and Timmerman, Dirk},
  issn         = {1423-002X},
  keyword      = {Pattern recognition,Subjective impression,Ovarian tumors,Ultrasound experience,Diagnostic confidence,Statistical models,Risk of malignancy},
  language     = {eng},
  number       = {3},
  pages        = {160--168},
  publisher    = {Karger},
  series       = {Gynecologic and Obstetric Investigation},
  title        = {Ultrasound Experience Substantially Impacts on Diagnostic Performance and Confidence when Adnexal Masses Are Classified Using Pattern Recognition},
  url          = {http://dx.doi.org/10.1159/000265012},
  volume       = {69},
  year         = {2010},
}