肿瘤细胞分数（TCF）估计是一项常见的临床任务，且存在已证实的较大的观察者间变异性。因此，它为评估采用计算机辅助诊断（TCFCAD）工具支持病理学家评估潜在影响提供了理想的实验平台。在一次全国幻灯片研讨会上，要求病理学家（n=69）在有意策划的多样化组织构成、细胞密度和染色强度的H&E结直肠癌图像中，对10个感兴趣区域（ROI）进行视觉估计TCF。随后，在为他们提供预测的肿瘤和非肿瘤细胞的TCFCAD创建的叠加显示以及相应的TCF百分比的同时，他们重新评估了相同的ROI。参与者还使用5级刻度报告了他们的评估信心水平，分别表示没有信心到高信心。TCF的地面真实值（GT）由专家进行了手动细胞计数来定义。在获得协助后，观察者间变异性显著降低，估计收敛于GT。即使TCFCAD的预测与GT稍有偏差，这种改善仍然存在。在ROI上估计的TCF与GT的标准差分别为9.9%与5.8%，差异显著（p < 0.0001）。组内相关系数从0.8增加到0.93（CI95%：[0.65, 0.93] vs [0.86, 0.98]），并且病理学家在获得帮助时表明更有信心（CAD：3.67 ± 0.81 vs. 4.17 ± 0.82）。TCFCAD估计支持显示了得分准确性、病理学家间一致性和评分信心的改善。有趣的是，病理学家在调查结束时还表示更愿意使用这种CAD工具，突显了培训/教育提高CAD系统采用的重要性。版权所有 © 2023. 由 Elsevier Inc. 发表。

Tumor cell fraction (TCF) estimation is a common clinical task with well-established large inter-observer variability. It thus provides an ideal testbed to evaluate potential impacts of employing a computer-aided diagnostic (TCFCAD) tool to support pathologists' evaluation. During a National Slide Seminar event, pathologists (n=69) were asked to visually estimate TCF in 10 regions of interest (ROI) from hematoxylin and eosin (H&E) colorectal cancer images intentionally curated for diverse tissue compositions, cellularity, and stain intensities. Next, they re-evaluated the same ROIs while being provided a TCFCAD created overlay highlighting predicted tumor versus non-tumor cells, together with the corresponding TCF percentage. Participants also reported confidence levels in their assessments using a 5-tiers scale, indicating no confidence to high confidence, respectively. The TCF ground truth (GT) was defined by manual cell-counting by experts. When assisted, inter-observer variability significantly decreased, showing estimates converging to the GT. This improvement remained even when TCFCAD predictions deviated slightly from the GT. The standard-deviation of estimated TCF to the GT across ROIs was 9.9% vs 5.8% with TCFCAD, p < 0.0001. The intraclass correlation coefficient increased from 0.8 to 0.93 (CI95% [0.65, 0.93] vs [0.86, 0.98]) and pathologists stated feeling more confident when aided (3.67 ± 0.81 vs. 4.17 ± 0.82 with CAD). TCFCAD estimation support demonstrated improved scoring accuracy, inter-pathologist agreement and scoring confidence. Interestingly, pathologists also expressed more willingness to use such a CAD tool at the end of the survey, highlighting the importance of training/education to increase adoption of CAD systems.Copyright © 2023. Published by Elsevier Inc.