Raab S S, Hart A R, D'Antonio J A, Grzybicki D M
Department of Pathology and Laboratory Medicine, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212, USA.
Am J Clin Pathol. 2001 May;115(5):681-8. doi: 10.1309/6AM2-BBEJ-PP0L-X7C4.
The degree to which clinical perceptions of Papanicolaou smear sensitivity contribute to patient mismanagement is uncertain. A voluntary, anonymous questionnaire was mailed to 350 obstetricians/gynecologists (OGYNs) and 350 other primary care providers (PCPs) located in Pennsylvania or Ohio. The clinicians estimated the probability of no disease, dysplasia, and invasive carcinoma for 1 of 7 Bethesda System diagnoses. Differences in probability estimates between provider types and between the clinicians and medical literature data were measured. The response rate was 22.7%. Compared with published values, clinicians estimated similar disease probabilities for many diagnoses. However, for some diagnoses, the probability estimates differed considerably from published values (e.g., overestimation of dysplasia and invasive carcinoma for benign diagnoses and underestimation of dysplasia for some dysplasia diagnoses), and such errors could contribute to patient mismanagement. OGYNs generally were more accurate in probability estimates than PCPs. Methods to convey more accurately these diagnostic disease probabilities should be examined.
巴氏涂片敏感性的临床认知在多大程度上导致患者管理不善尚不确定。一份自愿的匿名问卷被邮寄给位于宾夕法尼亚州或俄亥俄州的350名妇产科医生（OGYNs）和350名其他初级保健提供者（PCPs）。临床医生对贝塞斯达系统7种诊断中的1种，估计无疾病、发育异常和浸润性癌的概率。测量了提供者类型之间以及临床医生与医学文献数据之间概率估计的差异。回复率为22.7%。与已发表的值相比，临床医生对许多诊断估计的疾病概率相似。然而，对于某些诊断，概率估计与已发表的值有很大差异（例如，良性诊断中发育异常和浸润性癌的高估以及某些发育异常诊断中发育异常的低估），此类错误可能导致患者管理不善。妇产科医生在概率估计方面通常比初级保健提供者更准确。应研究更准确传达这些诊断疾病概率的方法。
