Influence of variability in assessment of Breslow thickness, mitotic rate and ulceration among US pathologists interpreting invasive melanoma, for the purpose of AJCC staging

Taylor, Laura A.; Hood, Kyle; Reisch, Lisa M.; Elmore, Joann G.; Piepkorn, Michael; Barnhill, Raymond L.; Knezevich, Stevan R.; Radick, Andrea C.; Elder, David E.

doi:10.1111/cup.13265

Cited by 8 publications

(21 citation statements)

References 20 publications

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“…Standardized BT is achieved through the use of an ocular micrometer measuring from the top of the granular cell layer of the epidermis to the deepest point of the invasion of the tumor (Breslow, 1975;Scolyer et al, 2013). The correct evaluation of BT is of critical importance because it can influence patient clinical assessment, prognostication, and management (Elmore et al, 2017;Lo et al, 2018;Niebling et al, 2013;Taylor et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Interobserver variability of BT may arise from differing levels of expertise among pathologists, though latest studies demonstrated an improvement in reproducibility (Bhoyrul et al, 2019;Elmore et al, 2018Elmore et al, , 2017Niebling et al, 2013;Taylor et al, 2018). Whether other specific pathologic features associated with BT, such as the presence of regression, periadnexal extensions of malignant melanocytes, and lymphocyte infiltrate, may influence melanoma prognosis is still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

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Defining the Prognostic Role of MicroRNAs in Cutaneous Melanoma

Dika

Riefolo

Porcellini

et al. 2020

Journal of Investigative Dermatology

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Defining the Prognostic Role of MicroRNAs in Cutaneous Melanoma

Dika

Riefolo

Porcellini

et al. 2020

Journal of Investigative Dermatology

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“…Moreover, treatment lasts one year and costs run over $20,000 per patient per month (2). Given that death rates from melanoma at 10 years range from 2% to 8% for stage I disease, 12%-25% for stage II disease, and 12%-40% for stage III disease, treating all patients with early-stage melanoma would result in significant overtreatment and resource expenditure (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…The current clinical criterion for evaluating risk of recurrence is the American Joint Committee on Cancer (AJCC) staging system (3,4). The AJCC staging system includes multiple parameters including depth of the primary tumor, ulceration, mitotic rate, and local or nodal metastasis.…”

Section: Introductionmentioning

confidence: 99%

“…First, it does not account for the relative risk conferred by tumor depth and lymph node spread in that a deeper primary is deadlier than a small nodal metastasis, such that a stage IIIA patient has a better survival rate than does a stage IIC patient. Second, depth can be difficult to estimate accurately in some patients depending on technique, for example, if a shave biopsy is performed or the original lesion is incompletely excised (4). Third, complete staging requires examination of lymph nodes, a procedure that is invasive and confers no survival benefit (5).…”

Section: Introductionmentioning

confidence: 99%

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Deep Learning Based on Standard H&E Images of Primary Melanoma Tumors Identifies Patients at Risk for Visceral Recurrence and Death

Kulkarni

Robinson

Pradhan

et al. 2019

Clinical Cancer Research

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Biomarkers for disease-specific survival (DSS) in earlystage melanoma are needed to select patients for adjuvant immunotherapy and accelerate clinical trial design. We present a pathology-based computational method using a deep neural network architecture for DSS prediction.Experimental Design: The model was trained on 108 patients from four institutions and tested on 104 patients from Yale School of Medicine (YSM, New Haven, CT). A receiver operating characteristic (ROC) curve was generated on the basis of vote aggregation of individual image sequences, an optimized cutoff was selected, and the computational model was tested on a third independent population of 51 patients from Geisinger Health Systems (GHS).Results: Area under the curve (AUC) in the YSM patients was 0.905 (P < 0.0001). AUC in the GHS patients was 0.880 (P < 0.0001). Using the cutoff selected in the YSM cohort, the computational model predicted DSS in the GHS cohort based on Kaplan-Meier (KM) analysis (P < 0.0001).Conclusions: The novel method presented is applicable to digital images, obviating the need for sample shipment and manipulation and representing a practical advance over current genetic and IHC-based methods.

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Pathologist Characteristics Associated With Rendering Higher-Grade Diagnoses for Melanocytic Lesions

Kerr,

Elder,

Piepkorn

et al. 2023

JAMA Dermatol

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ImportanceThe incidence of melanoma diagnoses has been increasing in recent decades, and controlled studies have indicated high histopathologic discordance across the intermediate range of melanocytic lesions. The respective causes for these phenomena remain incompletely understood.ObjectiveTo identify pathologist characteristics associated with tendencies to diagnose melanocytic lesions as higher grade vs lower grade or to diagnose invasive melanoma vs any less severe diagnosis.Design, Setting, and ParticipantsThis exploratory study used data from 2 nationwide studies (the Melanoma Pathology [M-Path] study, conducted from July 2013 to May 2016, and the Reducing Errors in Melanocytic Interpretations [REMI] study, conducted from August 2018 to March 2021) in which participating pathologists who interpreted melanocytic lesions in their clinical practices interpreted study cases in glass slide format. Each pathologist was randomly assigned to interpret a set of study cases from a repository of skin biopsy samples of melanocytic lesions; each case was independently interpreted by multiple pathologists. Data were analyzed from July 2022 to February 2023.Main Outcomes and MeasuresThe association of pathologist characteristics with diagnosis of a study case as higher grade (including severely dysplastic and melanoma in situ) vs lower grade (including mild to moderately dysplastic nevi) and diagnosis of invasive melanoma vs any less severe diagnosis was assessed using logistic regression. Characteristics included demographics (age, gender, and geographic region), years of experience, academic affiliation, caseload of melanocytic lesions in their practice, specialty training, and history of malpractice suits.ResultsA total of 338 pathologists were included: 113 general pathologists and 74 dermatopathologists from M-Path and 151 dermatopathologists from REMI. The predominant factor associated with rendering more severe diagnoses was specialist training in dermatopathology (board certification and/or fellowship training). Pathologists with this training were more likely to render higher-grade diagnoses (odds ratio [OR], 2.63; 95% CI, 2.10-3.30; P &lt; .001) and to diagnose invasive melanoma (OR, 1.95; 95% CI, 1.53-2.49; P &lt; .001) than pathologists without this training interpreting the same case. Nonmitogenic pT1a diagnoses (stage pT1a melanomas with no mitotic activity) accounted for the observed difference in diagnosis of invasive melanoma; when these lesions, which carry a low risk of metastasis, were grouped with the less severe diagnoses, there was no observed association (OR, 0.95; 95% CI, 0.74-1.23; P = .71). Among dermatopathologists, those with a higher caseload of melanocytic lesions in their practice were more likely to assign higher-grade diagnoses (OR for trend, 1.27; 95% CI, 1.04-1.56; P = .02).Conclusions and RelevanceThe findings suggest that specialty training in dermatopathology is associated with a greater tendency to diagnose atypical melanocytic proliferations as pT1a melanomas. These low-risk melanomas constitute a growing proportion of melanomas diagnosed in the US.

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Influence of variability in assessment of Breslow thickness, mitotic rate and ulceration among US pathologists interpreting invasive melanoma, for the purpose of AJCC staging

Abstract: Variability in the staging of T1 melanoma among pathologists when using the AJCC seventh edition criteria is closely related to the detection of mitotic figures, with BT playing a less prominent role. Decreased variability is expected after implementation of the eighth edition.

Cited by 8 publications

References 20 publications

Defining the Prognostic Role of MicroRNAs in Cutaneous Melanoma

Defining the Prognostic Role of MicroRNAs in Cutaneous Melanoma

Deep Learning Based on Standard H&E Images of Primary Melanoma Tumors Identifies Patients at Risk for Visceral Recurrence and Death

Pathologist Characteristics Associated With Rendering Higher-Grade Diagnoses for Melanocytic Lesions

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