Marchevsky Alberto M
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Semin Diagn Pathol. 2005 May;22(2):156-66. doi: 10.1053/j.semdp.2006.01.003.
Proponents of evidence-based medicine (EBM) have emphasized the need to consider the quality of different sources of medical information and have proposed various methods to integrate available "best evidence" into rules, guidelines and other diagnostic, therapeutic and prognostic models. The various factors that can affect the internal validity of studies in anatomic pathology, such as interobserver variability, use of retrospective rather than prospective data and others, are reviewed. The need for testing for the external validity of the results of anatomic pathology studies is introduced, using "test sets" of cases that have not been used to generate the classification or prognostic models. This methodology has been seldom used in anatomic pathology to validate the generalizability of various "entities," usefulness of diagnostic tests under different conditions and other information. Basic concepts of meta-analysis for research synthesis are introduced; these methods have been seldom used in anatomic pathology to integrate information from different studies using quantitative techniques rather than summary tables that merely list the results of various publications. The potential use of decision analysis and value of information analysis for the adoption of new tests is briefly discussed.
循证医学（EBM）的支持者强调了考虑不同医学信息来源质量的必要性，并提出了各种方法，将现有的“最佳证据”整合到规则、指南以及其他诊断、治疗和预后模型中。本文回顾了可能影响解剖病理学研究内部有效性的各种因素，如观察者间的变异性、使用回顾性而非前瞻性数据等。本文还介绍了使用未用于生成分类或预后模型的病例“测试集”来检验解剖病理学研究结果外部有效性的必要性。这种方法在解剖病理学中很少用于验证各种“实体”的普遍性、不同条件下诊断测试的有用性及其他信息。本文介绍了用于研究综合的荟萃分析的基本概念；这些方法在解剖病理学中很少用于使用定量技术而非仅仅列出各种出版物结果的汇总表来整合来自不同研究的信息。本文简要讨论了决策分析的潜在用途以及信息分析对采用新测试的价值。
