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Base-Rate Error in the Interpretation of Immunohistochemistry英文文献资料.doc

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Base-Rate Error in the Interpretation of Immunohistochemistry英文文献资料

SAGE-HindawiAccesstoResearch PathologyResearchInternational Volume2011,ArticleID636495,4pages doi:10.4061/2011/636495 ClinicalStudy Base-RateErrorintheInterpretationofImmunohistochemistry MalcolmGalloway DepartmentofCellularPathology,RoyalFreeHospital,RoyalFreeHampsteadNHSTrust,PondStreet,Hampstead,London, NW32QG,UK CorrespondenceshouldbeaddressedtoMalcolmGalloway,malcolm.galloway@ Received10February2011;Revised21March2011;Accepted23March2011 AcademicEditor:PabloA.Bejarano Copyright?2011MalcolmGalloway.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense, whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. Failuretoappreciatetheimportanceofthefrequencyofadisorderintheappropriatepopulation(thebaserate)mayleadtothe misinterpretationofthediagnosticsigni?canceofunexpectedtestresults(unexpectedtestresultde?nedinthiscontextasatest resultthatispositiveinahigherproportionofcasesofanalternativediagnosisthaninthediagnosisconsideredmostlikelybefore thetest).Thisstudyaimedtodeterminewhetherpathologistsarevulnerabletothiserror.Pathologistswereaskedtoestimatethe probabilityoftumourBinascenarioinwhich,priortotheimmunostainingresult,anexperiencedpathologistconsidersthereto bea99%chancethatthepatienthastumourAanda1%chancethattheyhavetumourB.AntibodyXispositivein80%ofcases oftumourBandnegativein90%ofcasesoftumourAandispositiveinthecasedescribedinthescenario.Theestimatesmade byconsultantpathologistsrangedfrom0to100%(mean29.7%).TheBayesiananswerwouldbe7.5%.These?ndingssuggest thatbase-rateerrormayleadsomepathologiststooverestimatetheimplicationsforthelikelihoodofadiagnosisinthelightofan unexpectedimmunohistochemicalresult. 1.Introduction theprobabilityofapatienthavingbreastcancerwouldbeif theyhada1%riskofthediseasepriortothemammogram but had a malignant diagnosis on mammography. In this scenario, the mathematically correct answer (by Bayesian analysis) would by 7.7%. He reported that approximately 95%ofp