Discordance of histopathologic parameters in cutaneous melanoma: Clinical implications

Patrawala, Samit; Maley, Alexander; Greskovich, Caitlin; Stuart, Lauren N.; Parker, Darien; Swerlick, Robert A.; Stoff, Benjamin K.

doi:10.1016/j.jaad.2015.09.008

Cited by 57 publications

(42 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies were constrained by small numbers of cases (eg, ≤20), 6 24-26 non-randomly selected cases, [27][28][29][30][31][32][33][34][35][36][37] narrow disease spectrum of cases, 5 Numbers of diagnostic interpretations with intraobserver agreement are emboldened. *Concordance rates are influenced by case composition, which included larger proportions of cases in classes II-V than would typically be encountered in practice.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study

Elmore

Barnhill

Elder

et al. 2017

BMJ

359

421

View full text Add to dashboard Cite

Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions. Design Observer accuracy and reproducibility study. Setting 10 US states. Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart. Main outcome measures Pathologists’ interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses. Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted. Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists’ visual assessments.

show abstract

Section: Comparison With Other Studiesmentioning

confidence: 99%

Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study

Elmore

Barnhill

Elder

et al. 2017

BMJ

359

421

View full text Add to dashboard Cite

show abstract

“…Another limitation is the considerable variability within lesions of the same category such as atypical Spitz tumors. 8 Pathologists examine slides and use the degree of atypia in formulating their treatment suggestions. Our survey did not provide photographs or slides of actual lesions to help pathologists guide treatment suggestions.…”

Section: Discussionmentioning

confidence: 99%

Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists

Lee

Peacock

Weinstock

et al. 2017

Journal of the American Academy of Dermatology

View full text Add to dashboard Cite

Background The extent of variability in treatment suggestions for melanocytic lesions made by pathologists is unknown. Objective We investigated how often pathologists rendered suggestions, reasons for providing suggestions, and concordance with national guidelines. Methods We conducted a cross-sectional survey of pathologists. Data included physician characteristics, experience, treatment recommendation practices. Results Of 301 pathologists, 207 (69%) from 10 states (CA, CT, HI, IA, KY, LA, NJ, NM, UT, WA), enrolled. Fifteen percent and 7% reported never and always including suggestions, respectively. Reasons for offering suggestions included improved care (79%), clarification (68%), and legal liability (39%). Reasons for not offering suggestions included referring physician preference (48%), lack of clinical information (44%), and expertise (29%). Training and caseload were associated with offering suggestions (p<0.05). Physician suggestions were most consistent for mild/moderate dysplastic nevi and melanoma. For melanoma in-situ, 18 (9%) and 32 (15%) pathologists made suggestions that under- or over-treated lesions based on NCCN guidelines, respectively. For invasive melanoma, 14 (7%) of pathologists made treatment suggestions that under-treated lesions based on NCCN guidelines. Limitations Treatment suggestions were self-reported. Conclusions Pathologists made recommendations ranging in consistency. These findings may inform efforts to reduce treatment variability and optimize patterns of care delivery for patients.

show abstract

“…• Inappropriate, incomplete removal of primary melanoma, with errors in Breslow thickness, ulceration and mitoses estimation; initial wide-excision of the primary tumour that may interfere with the subsequent SLNB procedure; inadequate detection, resection and evaluation of (sentinel) lymph nodes (Dandekar et al, 2014) • Different use of diagnostic terms/histopathological criteria by pathologists (Patrawala et al, 2016); incomplete histopathological reports; and not using the most recent TNM classification (Niebling et al, 2013) • Insufficient knowledge of and experience in detection and treatment of satellite or in-transit metastasis…”

Section: Stagingmentioning

confidence: 99%

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

Wouters

2018

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Discordance of histopathologic parameters in cutaneous melanoma: Clinical implications

Cited by 57 publications

References 36 publications

Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study

Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study

Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

Contact Info

Product

Resources

About