PDF(Pubmed)
Abstract：
UNASSIGNED: Confocal laser endomicroscopy (CLE) is an intraoperative real-time cellular resolution imaging technology that images brain tumor histoarchitecture. Previously, we demonstrated that CLE images may be interpreted by neuropathologists to determine the presence of tumor infiltration at glioma margins. In this study, we assessed neurosurgeons\' ability to interpret CLE images from glioma margins and compared their assessments to those of neuropathologists.
UNASSIGNED: In vivo CLE images acquired at the glioma margins that were previously reviewed by CLE-experienced neuropathologists were interpreted by four CLE-experienced neurosurgeons. A numerical scoring system from 0 to 5 and a dichotomous scoring system based on pathological features were used. Scores from assessments of hematoxylin and eosin (H&E)-stained sections and CLE images by neuropathologists from a previous study were used for comparison. Neurosurgeons\' scores were compared to the H&E findings. The inter-rater agreement and diagnostic performance based on neurosurgeons\' scores were calculated. The concordance between dichotomous and numerical scores was determined.
UNASSIGNED: In all, 4275 images from 56 glioma margin regions of interest (ROIs) were included in the analysis. With the numerical scoring system, the inter-rater agreement for neurosurgeons interpreting CLE images was moderate for all ROIs (mean agreement, 61%), which was significantly better than the inter-rater agreement for the neuropathologists (mean agreement, 48%) (p < 0.01). The inter-rater agreement for neurosurgeons using the dichotomous scoring system was 83%. The concordance between the numerical and dichotomous scoring systems was 93%. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 78%, 32%, 62%, and 50%, respectively, using the numerical scoring system and 80%, 27%, 61%, and 48%, respectively, using the dichotomous scoring system. No statistically significant differences in diagnostic performance were found between the neurosurgeons and neuropathologists.
UNASSIGNED: Neurosurgeons\' performance in interpreting CLE images was comparable to that of neuropathologists. These results suggest that CLE could be used as an intraoperative guidance tool with neurosurgeons interpreting the images with or without assistance of the neuropathologists. The dichotomous scoring system is robust yet simple and may streamline rapid, simultaneous interpretation of CLE images during imaging.
UNASSIGNED: In vivo CLE images acquired at the glioma margins that were previously reviewed by CLE-experienced neuropathologists were interpreted by four CLE-experienced neurosurgeons. A numerical scoring system from 0 to 5 and a dichotomous scoring system based on pathological features were used. Scores from assessments of hematoxylin and eosin (H&E)-stained sections and CLE images by neuropathologists from a previous study were used for comparison. Neurosurgeons\' scores were compared to the H&E findings. The inter-rater agreement and diagnostic performance based on neurosurgeons\' scores were calculated. The concordance between dichotomous and numerical scores was determined.
UNASSIGNED: In all, 4275 images from 56 glioma margin regions of interest (ROIs) were included in the analysis. With the numerical scoring system, the inter-rater agreement for neurosurgeons interpreting CLE images was moderate for all ROIs (mean agreement, 61%), which was significantly better than the inter-rater agreement for the neuropathologists (mean agreement, 48%) (p < 0.01). The inter-rater agreement for neurosurgeons using the dichotomous scoring system was 83%. The concordance between the numerical and dichotomous scoring systems was 93%. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 78%, 32%, 62%, and 50%, respectively, using the numerical scoring system and 80%, 27%, 61%, and 48%, respectively, using the dichotomous scoring system. No statistically significant differences in diagnostic performance were found between the neurosurgeons and neuropathologists.
UNASSIGNED: Neurosurgeons\' performance in interpreting CLE images was comparable to that of neuropathologists. These results suggest that CLE could be used as an intraoperative guidance tool with neurosurgeons interpreting the images with or without assistance of the neuropathologists. The dichotomous scoring system is robust yet simple and may streamline rapid, simultaneous interpretation of CLE images during imaging.
摘要：
■共聚焦激光显微内窥镜（CLE）是一种术中实时细胞分辨率成像技术，可对脑肿瘤组织结构进行成像。以前,我们证明CLE图像可以由神经病理学家解释,以确定神经胶质瘤边缘是否存在肿瘤浸润.在这项研究中,我们评估了神经外科医生从神经胶质瘤边缘解读CLE图像的能力,并将他们的评估结果与神经病理学家的评估结果进行了比较.
■先前由CLE经验丰富的神经病理学家审查的在神经胶质瘤边缘采集的体内CLE图像由四名CLE经验丰富的神经外科医生解释。使用从0到5的数字评分系统和基于病理特征的二分评分系统。使用来自先前研究的神经病理学家的苏木精和曙红(H&E)染色切片的评估和CLE图像的得分进行比较。将神经外科医生的评分与H&E结果进行比较。计算了基于神经外科医生评分的评估者之间的一致性和诊断表现。确定了二分和数值分数之间的一致性。
■总之，分析中包括来自56个神经胶质瘤边缘感兴趣区域（ROI）的4275张图像。有了数字评分系统，对于所有ROI，神经外科医生解释CLE图像的评估者之间的协议是中等的(平均协议，61%），明显优于神经病理学家的评估者之间的协议(平均协议，48%)(p<0.01)。使用二分法评分系统的神经外科医生的评分者之间的一致性为83％。数值和二分法评分系统之间的一致性为93％。整体灵敏度,特异性，正预测值，阴性预测值为78%，32%,62%,50%,分别,使用数字评分系统和80%，27%,61%,48%,分别,使用二分法评分系统。神经外科医生和神经病理学家之间的诊断性能没有统计学上的显着差异。
■神经外科医生在解释CLE图像方面的表现与神经病理学家相当。这些结果表明，CLE可以用作神经外科医生在有或没有神经病理学家的帮助下解释图像的术中指导工具。二分法评分系统既强大又简单，可以快速精简，在成像过程中同时解释CLE图像。
■先前由CLE经验丰富的神经病理学家审查的在神经胶质瘤边缘采集的体内CLE图像由四名CLE经验丰富的神经外科医生解释。使用从0到5的数字评分系统和基于病理特征的二分评分系统。使用来自先前研究的神经病理学家的苏木精和曙红(H&E)染色切片的评估和CLE图像的得分进行比较。将神经外科医生的评分与H&E结果进行比较。计算了基于神经外科医生评分的评估者之间的一致性和诊断表现。确定了二分和数值分数之间的一致性。
■总之，分析中包括来自56个神经胶质瘤边缘感兴趣区域（ROI）的4275张图像。有了数字评分系统，对于所有ROI，神经外科医生解释CLE图像的评估者之间的协议是中等的(平均协议，61%），明显优于神经病理学家的评估者之间的协议(平均协议，48%)(p<0.01)。使用二分法评分系统的神经外科医生的评分者之间的一致性为83％。数值和二分法评分系统之间的一致性为93％。整体灵敏度,特异性，正预测值，阴性预测值为78%，32%,62%,50%,分别,使用数字评分系统和80%，27%,61%,48%,分别,使用二分法评分系统。神经外科医生和神经病理学家之间的诊断性能没有统计学上的显着差异。
■神经外科医生在解释CLE图像方面的表现与神经病理学家相当。这些结果表明，CLE可以用作神经外科医生在有或没有神经病理学家的帮助下解释图像的术中指导工具。二分法评分系统既强大又简单，可以快速精简，在成像过程中同时解释CLE图像。
