Do we truly see what we think we see? The role of cognitive bias in pathological interpretation.

Détails

ID Serval
serval:BIB_487CC689EB73
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Do we truly see what we think we see? The role of cognitive bias in pathological interpretation.
Périodique
Journal of Pathology
Auteur(s)
Fandel T.M., Pfnür M., Schäfer S.C., Bacchetti P., Mast F.W., Corinth C., Ansorge M., Melchior S.W., Thüroff J.W., Kirkpatrick C.J., Lehr H.A.
ISSN
1096-9896
Statut éditorial
Publié
Date de publication
2008
Peer-reviewed
Oui
Volume
216
Numéro
2
Pages
193-200
Langue
anglais
Résumé
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.
Mots-clé
Adenocarcinoma, Adult, Aged, Cell Nucleus, Clinical Competence, Cognition, Diagnostic Errors, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Pathology, Clinical, Prejudice, Prognosis, Proportional Hazards Models, Prostate, Prostatectomy, Prostatic Neoplasms, ROC Curve
Pubmed
Web of science
Création de la notice
03/03/2009 11:28
Dernière modification de la notice
20/08/2019 13:55
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