Psychosocial factors and the course of cervical intra-epithelial neoplasia: a prospective study

OBJECTIVE

To investigate the influence of psychosocial factors on the course of cervical intra-epithelial neoplasia (CIN).

METHODS

A group of 93 patients with CIN 1 or 2 was followed for 2.25 years by half-yearly colposcopy and cytology. Negatively-rated life events, social support, and coping style were studied in relation to distress during follow-up and in relation to time till progression and regression of CIN. Human papillomavirus (HPV) infection was controlled for as well as sick role bias caused by suspicion of having cervical cancer and distress due to the abnormal cervical smear.

RESULTS

During follow-up, progression was found in 20 patients (22%), stable disease in 22 patients (24%), and regression in 51 patients (55%). Negatively-rated life events and lack of social support predicted distress longitudinally. No association was found between progression or regression of CIN and negatively-rated life events, lack of social support, coping style, and distress.

CONCLUSION

We found no evidence that psychosocial factors influence the course of CIN.

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.