The MPATH-Dx reporting schema for melanocytic proliferations and melanoma - 18/12/13

Doi : 10.1016/j.jaad.2013.07.027

Michael W. Piepkorn, MD, PhD ^a,^b,^c,^⁎ , Raymond L. Barnhill, MD ^d, David E. Elder, MBChB, FRCPA ^e, Stevan R. Knezevich, MD, PhD ^f, Patricia A. Carney, PhD ^g, Lisa M. Reisch, PhD ^b, Joann G. Elmore, MD ^b
^a Division of Dermatology, University of Washington School of Medicine, Seattle, Washington
^b Department of Medicine, University of Washington School of Medicine, Seattle, Washington
^c Dermatopathology Northwest, Bellevue, Washington
^d Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California
^e Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
^f Veterans Affairs Medical Center, Seattle, Washington
^g Department of Family Medicine, Oregon Health Sciences University, Portland, Oregon

^∗Reprint requests: Michael W. Piepkorn, MD, PhD, Division of Dermatology, Box 356524, University of Washington, Seattle, WA 98195.

Abstract

Background

The histologic diagnosis of melanoma and nevi can be subject to discordance and errors, potentially leading to inappropriate treatment and harm. Diagnostic terminology is not standardized, creating confusion for providers and patients and challenges for investigators.

Objective

We sought to describe the development of a pathology reporting form for more precise research on melanoma and a diagnostic-treatment mapping tool for improved patient care and consistency in treatment.

Methods

Three dermatopathologists independently reviewed melanocytic lesions randomly selected from a dermatopathology database. Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) reporting schema evolved from iterative case review and form revision.

Results

Differences in diagnostic thresholds, interpretation, and nomenclature contributed to development of the MPATH-Dx histology reporting form, which groups lesions by similarities in histogenesis and degrees of atypia. Because preliminary results indicate greater agreement regarding suggested treatments than for specific diagnoses, the diverse terminologies of the MPATH-Dx histology reporting form were stratified by commonalities of treatments in the MPATH-Dx diagnostic-treatment mapping scheme.

Limitations

Without transformative advances in diagnostic paradigms, the interpretation of melanocytic lesions frequently remains subjective.

Conclusions

The MPATH-Dx diagnostic-treatment mapping scheme could diminish confusion for those receiving reports by categorizing diverse nomenclature into a hierarchy stratified by suggested management interventions.

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Key words : diagnosis, diagnostic errors, discordance, dysplasia, melanoma, nevi, observer variability

Abbreviations used : AJCC, BI-RADS, MPATH-Dx

Plan

Methods

Selection and preparation of histologic cases

Independent review of cases

Consensus development meetings

Results

Development of the MPATH-Dx histology reporting form

Development of the MPATH-Dx diagnostic-treatment mapping scheme

Discussion

	Supported by the National Cancer Institute, National Institutes of Health (RO1CA151306).
	Disclosure: Dr Barnhill believes he has no relevant conflicts of interest to declare but discloses that he has received a grant from Abbott Diagnostics. Drs Piepkorn, Elder, Knezevich, Carney, Reisch, and Elmore have no conflicts of interest to declare.
	The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.