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Do we truly see what we think we see? The role of cognitive bias in pathological interpretation
The Journal of pathology, 2008-10, Vol.216 (2), p.193-200
Fandel, TM
Pfnür, M
Schäfer, SC
Bacchetti, P
Mast, FW
Corinth, C
Ansorge, M
Melchior, SW
Thüroff, JW
Kirkpatrick, CJ
Lehr, H.A
2008
Volltextzugriff (PDF)
Details
Autor(en) / Beteiligte
Fandel, TM
Pfnür, M
Schäfer, SC
Bacchetti, P
Mast, FW
Corinth, C
Ansorge, M
Melchior, SW
Thüroff, JW
Kirkpatrick, CJ
Lehr, H.A
Titel
Do we truly see what we think we see? The role of cognitive bias in pathological interpretation
Ist Teil von
The Journal of pathology, 2008-10, Vol.216 (2), p.193-200
Ort / Verlag
Chichester, UK: John Wiley & Sons, Ltd
Erscheinungsjahr
2008
Quelle
MEDLINE
Beschreibungen/Notizen
In the histomorphological grading of prostate carcinoma, pathologists have regularly assigned comparable scores for the architectural Gleason and the now-obsolete nuclear World Health Organization (WHO) grading systems. Although both systems demonstrate good correspondence between grade and survival, they are based on fundamentally different biological criteria. We tested the hypothesis that this apparent concurrence between the two grading systems originates from an interpretation bias in the minds of diagnostic pathologists, rather than reflecting a biological reality. Three pathologists graded 178 prostatectomy specimens, assigning Gleason and WHO scores on glass slides and on digital images of nuclei isolated out of their architectural context. The results were analysed with respect to interdependencies among the grading systems, to tumour recurrence (PSA relapse > 0.1 ng/ml at 48 months) and robust nuclear morphometry, as assessed by computer-assisted image analysis. WHO and Gleason grades were strongly correlated (r = 0.82) and demonstrated identical prognostic power. However, WHO grades correlated poorly with nuclear morphology (r = 0.19). Grading of nuclei isolated out of their architectural context significantly improved accuracy for nuclear morphology (r = 0.55), but the prognostic power was virtually lost. In conclusion, the architectural organization of a tumour, which the pathologist cannot avoid noticing during initial slide viewing at low magnification, unwittingly influences the subsequent nuclear grade assignment. In our study, the prognostic power of the WHO grading system was dependent on visual assessment of tumour growth pattern. We demonstrate for the first time the influence a cognitive bias can have in the generation of an error in diagnostic pathology and highlight a considerable problem in histopathological tumour grading. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Sprache
Englisch
Identifikatoren
ISSN: 0022-3417
eISSN: 1096-9896
DOI: 10.1002/path.2395
Titel-ID: cdi_proquest_miscellaneous_69530768
Format
–
Schlagworte
Adenocarcinoma - pathology
,
Adult
,
Aged
,
Biological and medical sciences
,
carcinoma
,
Cell Nucleus - ultrastructure
,
Clinical Competence
,
Cognition
,
Diagnostic Errors
,
Gleason
,
Humans
,
Image Processing, Computer-Assisted
,
interpretation bias
,
Investigative techniques, diagnostic techniques (general aspects)
,
Male
,
Medical sciences
,
Middle Aged
,
nuclear tumour grading
,
Pathology, Clinical - methods
,
Pathology, Clinical - standards
,
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
,
Prejudice
,
Prognosis
,
Proportional Hazards Models
,
prostate
,
Prostate - pathology
,
Prostatectomy
,
Prostatic Neoplasms - pathology
,
ROC Curve
,
World Health Organization
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