Gallwas Julia, Mortensen U, Gaschler Rebecca, Stepp H, Ditsch Nina, Friese K, Dannecker C
Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany.
Lasers Surg Med. 2012 Jan;44(1):11-9. doi: 10.1002/lsm.21146. Epub 2012 Jan 3.
The aim of this study was to determine the diagnostic efficacy of backscattering intensity measurements in optical coherence tomography in identifying different grades of cervical intraepithelial dysplasia.
STUDY DESIGN/MATERIALS AND METHODS: OCT images were taken from 153 unsuspicious and suspicious areas of 30 fresh conisation and hysterectomy specimens, evaluated by two blinded investigators using a six-grade classification (normal, inflammation, CIN1, CIN2, CIN3, squamous carcinoma) and later compared to the corresponding histology. Differences between judgments based on either the histology or the OCT images were investigated employing Correspondence Analysis (CA). Further, we explored the extent as to which backscattering intensity profiles of OCT images contained the essential information required for a reliable and valid diagnosis, using Linear Discriminant Analysis (LDA).
The CA of histology- and OCT-based judgments suggests that the diagnostic process may be characterized in terms of two stochastically independent underlying ("latent") variables, the first of them reflecting the definiteness with which CIN classes are identified, the second reflecting a bias towards diagnosing inflammation on the side of the OCT-based judgments. This finding is supported by the results of LDAs, where histology and OCT categorizations differ in particular with respect to the positions of inflammation and CIN1. Possibly, a second canonical variable has to be assumed accounting for the evaluation of carcinoma.
The systematic differences between histology-based and OCT-based diagnoses suggest that the use of available information is influenced by perceptual and/or cognitive biases. Apart from this it seems that the profiles appear to provide a remarkably large amount of information determining the main course of the diagnostic process.
本研究旨在确定光学相干断层扫描中背向散射强度测量在识别不同等级宫颈上皮内瘤变中的诊断效能。
研究设计/材料与方法：从30个新鲜锥形切除标本和子宫切除标本的153个未被怀疑和可疑区域获取OCT图像，由两名不知情的研究人员使用六级分类法（正常、炎症、CIN1、CIN2、CIN3、鳞状细胞癌）进行评估，随后与相应的组织学结果进行比较。采用对应分析（CA）研究基于组织学或OCT图像的判断之间的差异。此外，我们使用线性判别分析（LDA）探讨了OCT图像的背向散射强度曲线在多大程度上包含可靠有效诊断所需的基本信息。
基于组织学和OCT的判断的对应分析表明，诊断过程可能由两个随机独立的潜在变量来表征，其中第一个反映识别CIN类别的确切程度，第二个反映基于OCT的判断在诊断炎症方面的偏差。这一发现得到了线性判别分析结果的支持，其中组织学和OCT分类在炎症和CIN1的位置上尤其不同。可能还需要假定第二个典型变量来解释癌的评估。
基于组织学和基于OCT的诊断之间的系统差异表明，可用信息的使用受到感知和/或认知偏差的影响。除此之外，似乎这些曲线似乎提供了大量决定诊断过程主要进程的信息。
