title: Ultrasound operators' confidence influences diagnosis of ovarian tumors - a study in China.
abstract: OBJECTIVE
  To assess the effect of ultrasound operators' confidence in diagnosis of ovarian cancer, and the factors influencing diagnostic accuracy.
  
  
  METHODS
  Ultrasound images of selected ovarian cancers and controls were evaluated by 8 sinologists who were instructed to diagnose and classify lesions into benign, borderline or malignant, and we use structured questionnaire to investigate the level of confidence. We analyzed the accuracy of diagnosis, including sensitivity, specificity, positive and negative likelihood ratios and accuracy depending on the different levels of confidence. In addition, factors influencing diagnostic accuracy was assessed by logistic regression analysis.
  
  
  RESULTS
  A total of 426 cases were examined. The confidence score was significantly increased with the level of accuracy (test for trend, p<0.05). Borderline tumors were most difficult to diagnose, and had lower accuracy, sensitivity and specificity compared with benign and primary invasive tumors. Working experience was positively closely associated with diagnosis accuracy. Logistic regression analysis revealed working experience and confidence score to be positively related to the diagnostic accuracy(OR, 95%CI, 1.68, 1.15-3.97 for working experience; OR, 95%CI, 3.75, 1.67-6.98 for confidence score).
  
  
  CONCLUSIONS
  Our study showed that level of confidence is positively associated with diagnostic performance, and the accuracy is greatly influenced by working experience and confidence score.
authors.affiliation: Ultrasonography Department, The Affiliated Hospital of Guangdong Medical College, Zhanjiang, China.
authors.forename: Huang
authors.initials: H
authors.lastname: Haiyan
authors.forename: Deng
authors.initials: D
authors.lastname: Min
mesh_terms: D002681:China; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D059232:Laboratory Personnel / Q000523:psychology*; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires; D018608:Ultrasonography, Doppler