Assessment of Second-Opinion Strategies for Diagnoses of Cutaneous Melanocytic Lesions

Piepkorn, Michael; Longton, Gary; Reisch, Lisa M.; Elder, David E.; Pepe, Margaret S.; Kerr, Kathleen F.; Tosteson, Anna N.A.; Nelson, Heidi D; Knezevich, Stevan R.; Radick, Andrea C.; Shucard, Hannah; Onega, Tracy; Carney, Patricia A.; Elmore, Joann G.; Barnhill, Raymond L.

doi:10.1001/jamanetworkopen.2019.12597

Cited by 34 publications

(41 citation statements)

References 23 publications

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“…Histopathology is the gold standard for skin lesion diagnosis, but studies have shown poor inter-and intra-rater concordance and reproducibility for melanoma diagnosis (Piepkorn et al, 2019). AI has the potential to increase the accuracy and reproducibility of results, particularly if molecular diagnostics are used for model training.…”

Section: Dermatopathologymentioning

confidence: 99%

Artificial Intelligence in Dermatology: A Primer

Young

Xiong

Pfau

et al. 2020

Journal of Investigative Dermatology

146

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Artificial intelligence is becoming increasingly important in dermatology, with studies reporting accuracy matching or exceeding dermatologists for the diagnosis of skin lesions from clinical and dermoscopic images. However, real-world clinical validation is currently lacking. We review dermatological applications of deep learning, the leading artificial intelligence technology for image analysis, and discuss its current capabilities, potential failure modes, and challenges surrounding performance assessment and interpretability. We address the following three primary applications: (i) teledermatology, including triage for referral to dermatologists; (ii) augmenting clinical assessment during face-to-face visits; and (iii) dermatopathology. We discuss equity and ethical issues related to future clinical adoption and recommend specific standardization of metrics for reporting model performance.

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Section: Dermatopathologymentioning

confidence: 99%

Artificial Intelligence in Dermatology: A Primer

Young

Xiong

Pfau

et al. 2020

Journal of Investigative Dermatology

146

View full text Add to dashboard Cite

show abstract

“…While this paper reports survey results, we acknowledge that the utility of MPATH‐Dx must ultimately be evaluated through its implementation in clinical practice. We also acknowledge that the diagnostic process involves evaluating variables that are on a continuous scale and judging them against thresholds 30 . Morphological diagnosis is inherently challenging, and any diagnostic schema, whether morphological or ancillary, should avoid imparting a misleading sense of precision.…”

Section: Discussionmentioning

confidence: 99%

Terminology for melanocytic skin lesions and the MPATH‐Dx classification schema: A survey of dermatopathologists

et al. 2020

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Background Diagnostic terms used in histopathology reports of cutaneous melanocytic lesions are not standardized. We describe dermatopathologists' views regarding diverse diagnostic terminology and the utility of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH‐Dx) for categorizing melanocytic lesions. Methods July 2018‐2019 survey of board‐certified and/or fellowship‐trained dermatopathologists with experience interpreting melanocytic lesions. Results Among 160 participants, 99% reported witnessing different terminology being used for the same melanocytic lesion. Most viewed diverse terminology as confusing to primary care physicians (98%), frustrating to pathologists (83%), requiring more of their time as a consultant (64%), and providing necessary clinical information (52%). Most perceived that adoption of the MPATH‐Dx would: improve communication with other pathologists and treating physicians (87%), generally be a change for the better (80%), improve patient care (79%), be acceptable to clinical colleagues (68%), save time in pathology report documentation (53%), and protect from malpractice (51%). Conclusions Most dermatopathologists view diverse terminology as contributing to miscommunication with clinicians and patients, adversely impacting patient care. They view the MPATH‐Dx as a promising tool to standardize terminology and improve communication. The MPATH‐Dx may be a useful supplement to conventional pathology reports. Further revision and refinement are necessary for widespread clinical use.

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“…While second and third opinions from trained dermatopathologists can reduce the misclassification rate of a general pathologist, additional peer review has a smaller, but still significant, benefit when a dermatopathologist performs the initial read (19). If these findings reflect the pathology community, then three highly trained dermatopathologists reviewing the same class II, III, or IV case, would be expected to have a consensus accuracy of 35, 52, and 62%, respectively (19). These studies indicate that training and experience are not sufficient to reach high levels of accuracy for intermediate lesions.…”

Section: The Case For Biomarkers In Melanoma Diagnosis and Treatmentmentioning

confidence: 99%

Molecular Biomarkers for Melanoma Screening, Diagnosis and Prognosis: Current State and Future Prospects

2021

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Despite significant progress in the development of treatment options, melanoma remains a leading cause of death due to skin cancer. Advances in our understanding of the genetic, transcriptomic, and morphologic spectrum of benign and malignant melanocytic neoplasia have enabled the field to propose biomarkers with potential diagnostic, prognostic, and predictive value. While these proposed biomarkers have the potential to improve clinical decision making at multiple critical intervention points, most remain unvalidated. Clinical validation of even the most commonly assessed biomarkers will require substantial resources, including limited clinical specimens. It is therefore important to consider the properties that constitute a relevant and clinically-useful biomarker-based test prior to engaging in large validation studies. In this review article we adapt an established framework for determining minimally-useful biomarker test characteristics, and apply this framework to a discussion of currently used and proposed biomarkers designed to aid melanoma detection, staging, prognosis, and choice of treatment.

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Assessment of Second-Opinion Strategies for Diagnoses of Cutaneous Melanocytic Lesions

Abstract: This diagnostic study evaluates whether fellowship training and board certification of physicians in dermatopathology affect the diagnostic reliability of second-opinion strategies for difficult-to-diagnose cutaneous melanocytic lesions.

Cited by 34 publications

References 23 publications

Artificial Intelligence in Dermatology: A Primer

Artificial Intelligence in Dermatology: A Primer

Terminology for melanocytic skin lesions and the MPATH‐Dx classification schema: A survey of dermatopathologists

Molecular Biomarkers for Melanoma Screening, Diagnosis and Prognosis: Current State and Future Prospects

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