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Abstract：
Objectives: Discrimination of nasal cavity lesions using nasal endoscopy is challenging because of the differences in clinical manifestations and treatment strategies. We aimed to investigate the diagnostic accuracy of clinical visual assessment (CVA) of nasal cavity masses using endoscopic images and determine whether there is a difference according to pathologic class and the examiners\' experience. Methods: We collected pathologically confirmed endoscopic images of normal findings, nasal polyp (NP), benign tumor, and malignant tumor (each class contained 100 images) randomly selected. Eighteen otolaryngologists, including six junior residents, six senior residents, and six board-certified rhinologists classified the test set images into four classes of lesions by CVA. Diagnostic performance according to the pathologic class and the examiner\'s experience level was evaluated based on overall accuracy, F1-score, confusion matrix, and area under the receiver operating characteristic curve (AUC). Results: Diagnostic performance was significantly different according to the pathological class of nasal cavity mass lesions with the overall accuracy reported high in the order of normal, NP, benign tumor, and malignant tumor (0.926 ± 0.100; 0.819 ± 0.135; 0.580 ± 0.112; 0.478 ± 0.187, respectively), F1 score (0.937 ± 0.076; 0.730 ± 0.093; 0.549 ± 0.080; 0.554 ± 0.146, respectively) and AUC value (0.96 ± 0.06; 0.84 ± 0.07; 0.70 ± 0.05; 0.71 ± 0.08, respectively). The expert rhinologist group achieved higher overall accuracy than the resident group (0.756 ± 0.157 vs. 0.680 ± 0.239, p < .05). Conclusion: CVA for nasal cavity mass was highly dependent on the pathologic class and examiner\'s experience. The overall accuracy was reliably high for normal findings, but low in classifying benign and malignant tumors. Differential diagnosis of lesions solely based on nasal endoscopic evaluation is challenging. Therefore, clinicians should consider further clinical evaluation for suspicious cases.
摘要：
目的：由于临床表现和治疗策略的差异，使用鼻内镜识别鼻腔病变具有挑战性。我们旨在研究使用内窥镜图像对鼻腔肿块进行临床视觉评估（CVA）的诊断准确性，并根据病理类别和检查者的经验确定是否存在差异。方法:收集经病理证实的正常内镜图像,鼻息肉(NP),良性肿瘤,和恶性肿瘤（每类包含100张图像）随机选择。18名耳鼻喉科医师,包括六名初级居民，六名高级居民，六位董事会认证的鼻学家通过CVA将测试集图像分为四类病变。根据病理类别和检查者的经验水平进行诊断表现，并根据总体准确性进行评估。F1分数，混淆矩阵，和接受者工作特征曲线下面积(AUC)。结果：根据鼻腔肿块病变的病理分级，诊断表现有明显差异，总体报告的准确性按正常顺序较高，NP,良性肿瘤,和恶性肿瘤（分别为0.926±0.100;0.819±0.135;0.580±0.112;0.478±0.187），F1评分(分别为0.937±0.076;0.730±0.093;0.549±0.080;0.554±0.146)和AUC值(分别为0.96±0.06;0.84±0.07;0.70±0.05;0.71±0.08)。鼻专家组的总体准确性高于居民组（0.756±0.157vs.0.680±0.239，p<0.05）。结论：鼻腔肿块的CVA高度依赖于病理类型和检查者的经验。对于正常发现，总体准确性可靠地高，但对良性和恶性肿瘤的分类很低。仅基于鼻内镜评估的病变鉴别诊断具有挑战性。因此,临床医师应考虑对可疑病例进行进一步的临床评估.
