Article: Visualising scanning patterns of pathologists in the grading of cervical intraepithelial neoplasia

Aim: To investigate how effectively eye tracking devices can visualise the scanning patterns of pathologists, for application in studies on diagnostic decision making.

Methods: EyeCatcher, an eye tracking device, was used to visualise and compare the scanning patterns of five pathologists while they graded two projections of cervical intraepithelial neoplasia. Density cloud images were created from the scanning patterns. A questionnaire and interview provided information on the following steps in the diagnostic process.

Results: EyeCatcher successfully registered the scanning patterns of the pathologists. A "scanning style" and a "selective style" of visual search were distinguished. The scanning patterns, in addition to the interpretation and combination of the information ultimately leading to a diagnosis, varied between the various observers, resulting in a broad range of final diagnoses.

Conclusions: Eye gaze tracking devices provide an excellent basis for further discussion on the interpretation and grading criteria of lesions. As such, they may play an important role in studies on diagnostic decision making in pathology and in the development of training and quality control programmes for pathologists.

Citing Articles

Eye tracking in digital pathology: A comprehensive literature review.

Lopes A, Ward A, Cecchini M J Pathol Inform. 2024; 15:100383.

PMID: 38868488 PMC: 11168484. DOI: 10.1016/j.jpi.2024.100383.

Eye tracking reveals expertise-related differences in the time-course of medical image inspection and diagnosis.

Brunye T, Drew T, Kerr K, Shucard H, Weaver D, Elmore J J Med Imaging (Bellingham). 2023; 7(5):051203.

PMID: 37476351 PMC: 10355124. DOI: 10.1117/1.JMI.7.5.051203.

Oral presentation assessment and image reading behaviour on brain computed tomography reading in novice clinical learners: an eye-tracking study.

Liu C, Hung J, Chang C, Lin J, Huang E, Wang S BMC Med Educ. 2022; 22(1):738.

PMID: 36284299 PMC: 9597969. DOI: 10.1186/s12909-022-03795-9.

Differences in Gaze Fixation Location and Duration Between Resident and Fellowship Sonographers Interpreting a Focused Assessment With Sonography in Trauma.

Bell C, Szulewski A, Walker M, McKaigney C, Ross G, Rang L AEM Educ Train. 2021; 5(1):28-36.

PMID: 33521488 PMC: 7821074. DOI: 10.1002/aet2.10439.

Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images.

Brunye T, Mercan E, Weaver D, Elmore J J Biomed Inform. 2017; 66:171-179.

PMID: 28087402 PMC: 5316368. DOI: 10.1016/j.jbi.2017.01.004.

References

1.

Crowley R, Naus G, Stewart 3rd J, Friedman C . Development of visual diagnostic expertise in pathology -- an information-processing study. J Am Med Inform Assoc. 2003; 10(1):39-51. PMC: 150358. DOI: 10.1197/jamia.m1123. View

2.

Cocker J, Fox H, Langley F . Consistency in the histological diagnosis of epithelial abnormalities of the cervix uteri. J Clin Pathol. 1968; 21(1):67-70. PMC: 473666. DOI: 10.1136/jcp.21.1.67. View

3.

RINGSTED J, Amtrup F, Asklund C, Baunsgaard P, Christensen H, Hansen L . Reliability of histo-pathological diagnosis of squamous epithelial changes of the uterine cervix. Acta Pathol Microbiol Scand A. 1978; 86(4):273-8. DOI: 10.1111/j.1699-0463.1978.tb02043.x. View

4.

Robertson A, Anderson J, BECK J, Burnett R, Howatson S, Lee F . Observer variability in histopathological reporting of cervical biopsy specimens. J Clin Pathol. 1989; 42(3):231-8. PMC: 1141860. DOI: 10.1136/jcp.42.3.231. View

5.

Ismail S, Colclough A, Dinnen J, Eakins D, Evans D, Gradwell E . Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia. BMJ. 1989; 298(6675):707-10. PMC: 1835992. DOI: 10.1136/bmj.298.6675.707. View

6.

Barrett J, deParedes E, Dwyer 3rd S, Merickel M, Hutchinson T . Unobtrusively tracking eye gaze direction and pupil diameter of mammographers. Acad Radiol. 1994; 1(1):40-5. DOI: 10.1016/s1076-6332(05)80782-2. View

7.

Anderson M, Brown C, Buckley C, Fox H, Jenkins D, Lowe D . Current views on cervical intraepithelial neoplasia. J Clin Pathol. 1991; 44(12):969-78. PMC: 494963. DOI: 10.1136/jcp.44.12.969. View

8.

KUNDEL H, NODINE C, Krupinski E . Searching for lung nodules. Visual dwell indicates locations of false-positive and false-negative decisions. Invest Radiol. 1989; 24(6):472-8. View

9.

NODINE C, KUNDEL H, Lauver S, Toto L . Nature of expertise in searching mammograms for breast masses. Acad Radiol. 1996; 3(12):1000-6. DOI: 10.1016/s1076-6332(96)80032-8. View

10.

Hu C, KUNDEL H, NODINE C, Krupinski E, Toto L . Searching for bone fractures: a comparison with pulmonary nodule search. Acad Radiol. 1994; 1(1):25-32. DOI: 10.1016/s1076-6332(05)80780-9. View

11.

KUNDEL H, NODINE C, Toto L . Searching for lung nodules. The guidance of visual scanning. Invest Radiol. 1991; 26(9):777-81. DOI: 10.1097/00004424-199109000-00001. View

Visualising Scanning Patterns of Pathologists in the Grading of Cervical Intraepithelial Neoplasia