Diagnostic concordance rates in the subtyping of basal cell carcinoma by different dermatopathologists

Abstract

Journal of Cutaneous PathologyDiagnostic concordance rates in the subtyping of basal cell carcinoma by different dermatopathologists Background There are numerous subtypes of basal cell carcinoma (BCC). Defining the histopathologic subtype is an essential element in patient management, but there is little known data regarding interobserver precision in subtyping BCC. Methods We studied interobserver variance between six board-certified dermatopathologists who subtyped 100 BCCs in a blinded fashion. We used kappa statistic to calculate the concordance in suggested subtype by different dermatopathologists. Provided diagnoses were then re-categorized into low-risk and high-risk phenotypes, and kappa statistic for concordance on high-risk BCC was determined. Results The overall κ statistic was 0.301, indicating fair agreement among the six observers. Superficial and fibroepithelial BCC had the highest individual kappa statistics. When subtypes were re-classified into a two-tier system of high-risk and low-risk phenotypes, there was substantial interobserver agreement on high-risk BCC with a κ statistic of 0.699. Conclusion These results suggest only fair agreement among dermatopathologists on specific BCC subtypes, but substantial agreement on superficial, fibroepithelial and high-risk BCC growth patterns. A simplified classification system comprised of superficial, fibroepithelial, nodular and infiltrative subtypes would increase interobserver precision and facilitate clinical decision-making.

Reliability of diagnosis from Mohs slides: interpersonal and intrapersonal agreement on basal cell carcinoma presence and histological subtype

“…In line with Nedved et al ., we observed a somewhat lower level of agreement on BCC subtyping than on BCC presence . This is logically explained because BCC presence (yes or no) is a binary question while the differentiation between BCC subtypes is less strict and mixed subtypes are common.…”

“…In line with Nedved et al, we observed a somewhat lower level of agreement on BCC subtyping than on BCC presence. 23 This is logically explained because BCC presence (yes or no) is a binary question while the differentiation between BCC subtypes is less strict and mixed subtypes are common. To improve the diagnostic concordance in BCC subtyping, it might be necessary to further specify and simplify the current World Health Organization classification of BCC subtypes.…”

Is early detection of basal cell carcinoma worthwhile? Systematic review based on the WHO criteria for screening

“…Up to 66 BCC subtypes are described in the scientific literature. A recent study suggested a simplified classification to aid clinical decision making in the superficial, fibroepithelial, nodular and infiltrative subtypes . Superficial BCCs (sBCCs) are considered to be the least aggressive subtype, as they do not tend to invade deeply in the dermis.…”

Investigation of P120catenin Expression in Human Basal Cell Carcinoma of the Skin

“…For the purpose of this study, we selected a set of representative samples of cutaneous BCCs included four histomorphological subtypes: superficial (8 cases), nodular (12 cases), mixed nodular-infiltrative (10 cases), and infiltrative (8 cases). Further, according to the previous reports (13,14) and recommendations proposed recently by The Royal College of Pathologists (15), they were divided into two separate subgroups for statistical analysis. The first subgroup comprised 20 low-risk (non-infiltrative) BCC subtypes (superficial and nodular).…”