Myung Jane S, Paul Chan Robison Vernon, Espiritu Michael J, Williams Steven L, Granet David B, Lee Thomas C, Weissgold David J, Chiang Michael F
Department of Ophthalmology, Weill-Cornell Medical Center, New York, New York, USA.
J AAPOS. 2011 Dec;15(6):573-8. doi: 10.1016/j.jaapos.2011.06.011.
To measure the accuracy of image-based retinopathy of prematurity (ROP) diagnosis by pediatric ophthalmology fellows.
This was a comparative case series of expert versus nonexpert clinicians in image-based ROP diagnosis. An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II, Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study website from which an expert pediatric retinal specialist and five pediatric ophthalmology fellows independently provided a diagnosis (no ROP, mild ROP, type 2 ROP, or treatment-requiring ROP) for each eye. Two different retinal specialists experienced in ROP examination served as additional controls. Primary outcome measures were sensitivity and specificity of image-based ROP diagnosis by fellows compared to a reference standard of image-based interpretation by the expert pediatric retinal specialist. Secondary outcome measure was intraphysician reliability.
For detection of mild or worse ROP, the mean (range) sensitivity among the five fellows was 0.850 (0.670-0.962) and specificity was 0.919 (0.832-0.964). For detection of type 2 or worse ROP by fellows, mean (range) sensitivity was 0.527 (0.356-0.709) and specificity was 0.938 (0.777-1.000). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.515 (0.267-0.765) and specificity was 0.949 (0.805-1.00).
Pediatric ophthalmology fellows in this study demonstrated high diagnostic specificity in image-based ROP diagnosis; however, sensitivity was lower, particularly for clinically significant disease.
评估儿科眼科住院医师基于图像诊断早产儿视网膜病变（ROP）的准确性。
这是一个基于图像的ROP诊断中专家与非专家临床医生的比较病例系列研究。使用广角相机（RetCam-II，Clarity Medical Systems，普莱森顿，加利福尼亚州）从67名早产儿的248只眼中获取了804张视网膜图像图谱。图像被上传到一个研究网站，一名儿科视网膜专家和五名儿科眼科住院医师分别独立地对每只眼睛给出诊断（无ROP、轻度ROP、2型ROP或需要治疗的ROP）。另外两名有ROP检查经验的视网膜专家作为对照。主要结局指标是住院医师基于图像的ROP诊断与儿科视网膜专家基于图像解读的参考标准相比的敏感性和特异性。次要结局指标是医生内部的可靠性。
对于检测轻度及以上ROP，五名住院医师的平均（范围）敏感性为0.850（0.670 - 0.962），特异性为0.919（0.832 - 0.964）。对于检测2型及以上ROP，住院医师的平均（范围）敏感性为0.527（0.356 - 0.709），特异性为0.938（0.777 - 1.000）。对于检测需要治疗的ROP，平均（范围）敏感性为0.515（0.267 - 0.765），特异性为0.949（0.805 - 1.00）。
本研究中的儿科眼科住院医师在基于图像的ROP诊断中表现出较高的诊断特异性；然而，敏感性较低，尤其是对于具有临床意义的疾病。
