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Westover, Kenneth Dale

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Kenneth Dale

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Westover, Kenneth Dale

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20112

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Author's Publications: search.filters.isAuthorOfPublication.a0eb7f59-bf1d-41df-8594-8b3d86cc9939

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    Should a Sentinel Node Biopsy Be Performed in Patients with High-Risk Breast Cancer?
    (SAGE-Hindawi Access to Research, 2011) Westover, Kenneth Dale; Westover, Michael; Winer, Eric; Richardson, Andrea; Iglehart, James; Punglia, Rinaa
    A negative sentinel lymph node (SLN) biopsy spares many breast cancer patients the complications associated with lymph node irradiation or additional surgery. However, patients at high risk for nodal involvement based on clinical characteristics may remain at unacceptably high risk of axillary disease even after a negative SLN biopsy result. A Bayesian nomogram was designed to combine the probability of axillary disease prior to nodal biopsy with customized test characteristics for an SLN biopsy and provides the probability of axillary disease despite a negative SLN biopsy. Users may individualize the sensitivity of an SLN biopsy based on factors known to modify the sensitivity of the procedure. This tool may be useful in identifying patients who should have expanded upfront exploration of the axilla or comprehensive axillary irradiation.
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    Significance Testing as Perverse Probabilistic Reasoning
    (BioMed Central, 2011) Westover, Michael; Westover, Kenneth Dale; Bianchi, Matt Travis
    Truth claims in the medical literature rely heavily on statistical significance testing. Unfortunately, most physicians misunderstand the underlying probabilistic logic of significance tests and consequently often misinterpret their results. This near-universal misunderstanding is highlighted by means of a simple quiz which we administered to 246 physicians at two major academic hospitals, on which the proportion of incorrect responses exceeded 90%. A solid understanding of the fundamental concepts of probability theory is becoming essential to the rational interpretation of medical information. This essay provides a technically sound review of these concepts that is accessible to a medical audience. We also briefly review the debate in the cognitive sciences regarding physicians' aptitude for probabilistic inference.