title: Subjective assessment of ovarian masses using pattern recognition: the impact of experience on diagnostic performance and interobserver variability.
abstract: OBJECTIVE
  To compare diagnostic performance and interobserver variability in a group of 36 examiners, with four different levels of experience.
  
  
  METHODS
  Nine junior trainees, eight level I senior trainees, 11 level II senior gynecologists, and eight level III expert sonologists classified 105 ultrasound images of adnexal masses into three subgroups of ovarian lesions (malignancies, functional cysts, and dermoid cysts).
  
  
  RESULTS
  The level III sonologists obtained the best diagnostic results together with the lowest interobserver variability (κ = 0.70, SD = 0.04). They achieved significantly better results in comparison with the junior trainees and also the senior trainees (κ = 0.51, SD = 0.12, p < 0.001; and κ = 0.51, SD = 0.09, p < 0.001). Differences between level III sonologists and the group of level II observers did not reach statistical significance (κ = 0.65, SD = 0.09, p = 0.70). There were no significant differences between senior and junior trainees (p = 1.0) and both groups achieved a significantly poorer diagnostic performance in comparison with the level II observers (p < 0.01 and p < 0.01). For all observers, the largest differences were seen for classifying malignancies, the best results for classifying functional cysts, and the poorest for evaluating dermoid cysts.
  
  
  CONCLUSIONS
  Diagnostic performance of pattern recognition significantly improves with an increasing level of experience, emphasizing the importance of standardized ultrasound training programs with supervision by experts.
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054 Erlangen, Germany. florian.faschingbauer@uk-erlangen.de
authors.forename: Florian
authors.initials: F
authors.lastname: Faschingbauer
authors.forename: Michaela
authors.initials: M
authors.lastname: Benz
authors.forename: Lothar
authors.initials: L
authors.lastname: Häberle
authors.forename: Tamme W
authors.initials: TW
authors.lastname: Goecke
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Renner
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Thomas
authors.initials: T
authors.lastname: Wittenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Münzenmayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D009929:Organ Size; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology*; D010364:Pattern Recognition, Visual; D014463:Ultrasonography; D055815:Young Adult