Applying a decision support system in clinical practice: results from melanoma diagnosis.
The work reported in this paper investigates the use of a decision-support tool for the diagnosis of pigmented skin lesions in a real-world clinical trial with 511 patients and 3827 lesion evaluations. We analyzed a number of outcomes of the trial, such as direct comparison of system performance in laboratory and clinical setting, the performance of physicians using the system compared to a control dermatologist without the system, and repeatability of system recommendations. The results show that system performance was significantly less in the real-world setting compared to the laboratory setting (c-index of 0.87 vs. 0.94, p = 0.01). Dermatologists using the system achieved a combined sensitivity of 85% and combined specificity of 95%. We also show that the process of acquiring lesion images using digital dermoscopy devices needs to be standardized before sufficiently high repeatability of measurements can be assured.
Dreiseitl
Stephan
S
Upper Austria University of Applied Sciences, Hagenberg, Austria.
Binder
Michael
M
Vinterbo
Staal
S
Kittler
Harald
H
D020000:Decision Support Systems, Clinical; D046169:Dermoscopy / Q000379:methods*; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*