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Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group - 20/07/16

Doi : 10.1016/j.jaad.2016.04.052 
Jason P. Lott, MD, MHS, MSHP a, Joann G. Elmore, MD, MPH b, , Ge A. Zhao, MD c, Stevan R. Knezevich, MD, PhD d, Paul D. Frederick, MPH, MBA b, Lisa M. Reisch, PhD b, Emily Y. Chu, MD, PhD e, Martin G. Cook, MD g, Lyn M. Duncan, MD h, Rosalie Elenitsas, MD e, Pedram Gerami, MD i, Gilles Landman, MD j, Lori Lowe, MD k, Jane L. Messina, MD l, Martin C. Mihm, MD m, Joost J. van den Oord, MD, PhD n, Michael S. Rabkin, MD, PhD o, Birgitta Schmidt, MD p, Christopher R. Shea, MD q, Sook Jung Yun, MD, PhD r, George X. Xu, MD, PhD f, Michael W. Piepkorn, MD, PhD c, David E. Elder, MBChB, FRCPA f, Raymond L. Barnhill, MD s
on behalf of the

International Melanoma Pathology Study Group

a Cornell Scott-Hill Health Center, New Haven, Connecticut 
b Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington 
c Division of Dermatology, University of Washington School of Medicine, Seattle, Washington 
d Pathology Associates, Clovis, California 
e Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
f Department of Pathology and Lab Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 
g University of Surrey Division of Clinical Medicine, Surrey, United Kingdom 
h Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 
i Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
j Department of Pathology, Universidade Federal de São Paulo–Escola Paulista de Medicina, São Paulo, Brazil 
k Department of Pathology and Dermatology, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan 
l Departments of Anatomic Pathology and Cutaneous Oncology, Moffitt Center, and Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, Florida 
m Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 
n Department of Pathology, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium 
o Rabkin Dermatopathology Laboratory PC, Tarentum, Pennsylvania 
p Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts 
q Section of Dermatology, University of Chicago Medicine, Chicago, Illinois 
r Department of Dermatology, Chonnam National University School of Medicine, Gwangju, Korea 
s Department of Pathology, Institut Curie and Faculty of Medicine, University of Paris Descartes, Paris, France 

Reprint requests: Joann G. Elmore, MD, MPH, Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98104-2499.Harborview Medical Center325 Ninth AveBox 359780SeattleWA98104-2499

Abstract

Background

Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care.

Objective

We sought to evaluate the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) scheme, a 5-category classification system for melanocytic lesions.

Methods

Participants (n = 16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when necessary, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Interrater agreement and correlation between MPATH-Dx categorization and treatment suggestions were evaluated.

Results

Most participants were board-certified dermatopathologists (n = 15), age 50 years or older (n = 12), male (n = 9), based in the United States (n = 11), and primary academic faculty (n = 14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement after MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 (95% confidence interval 0.68-0.71) and 0.72 (95% confidence interval 0.71-0.73), respectively, whereas correlation between MPATH-Dx categorization and treatment suggestions was 0.91.

Limitations

This was a small sample size of experienced pathologists in a testing situation.

Conclusion

Varying diagnostic nomenclature can be classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care.

Le texte complet de cet article est disponible en PDF.

Key words : classification, diagnosis, dysplastic nevus, melanoma, Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis, nevus, pathology, variability, variation

Abbreviations used : BI-RADS, CI, MPATH-Dx, SLN


Plan


 Supported by the National Cancer Institute (R01 CA151306 and K05 CA104699).
 Disclosure: Dr Lott is an employee of Bayer HealthCare Pharmaceuticals Inc. Dr Barnhill has received honoraria as a consultant for Myriad Genetics. Dr Elder has received honoraria as a consultant for Myriad Genetics, and royalties as a textbook editor for Lippincott Williams and Wilkins, Wolters Kluwer, and Demos Medical Publishing, and as an author of the Armed Forces Institute of Pathology's fascicles on melanocytic and nonmelanocytic tumor pathology. Dr Elenitsas has received honoraria as a consultant for Myriad Genetics and royalties as a textbook editor for Lippincott Williams and Wilkins. Dr Gerami has received honoraria as a consultant at DermTech Inc, Castle Biosciences, and Myriad Genetics. Dr Mihm has received honoraria as a textbook coauthor from Wiley and Sons Inc and advisory board member for Caliber ID, and received consulting fees as a consultant for Mela Sciences, Alnylam, and Novartis. Drs Elmore, Zhao, Knezevich, Reisch, Chu, Cook, Duncan, Landman, Lowe, Messina, van den Oord, Rabkin, Schmidt, Shea, Yun, Xu, and Piepkorn, and Mr Frederick have no conflicts of interest to declare.


© 2016  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 75 - N° 2

P. 356-363 - août 2016 Retour au numéro
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