Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation - 18/06/18
Abstract |
Background |
Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear.
Objective |
Identify pathologist characteristics associated with rates of accuracy and reproducibility.
Methods |
Pathologists independently interpreted the same set of biopsy specimens from melanocytic lesions on 2 occasions. Diagnoses were categorized into 1 of 5 classes according to the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis system. Reproducibility was determined by pathologists’ concordance of diagnoses across 2 occasions. Accuracy was defined by concordance with a consensus reference standard. Associations of pathologist characteristics with reproducibility and accuracy were assessed individually and in multivariable logistic regression models.
Results |
Rates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology and in those with 5 or more years of experience. In addition, accuracy was high among pathologists with a higher proportion of melanocytic lesions in their caseload composition and higher volume of melanocytic lesions.
Limitations |
Data gathered in a test set situation by using a classification tool not currently in clinical use.
Conclusion |
Diagnoses are more accurate among pathologists with specialty training and those with more experience interpreting melanocytic lesions. These findings support the practice of referring difficult cases to more experienced pathologists to improve diagnostic accuracy, although the impact of these referrals on patient outcomes requires additional research.
Il testo completo di questo articolo è disponibile in PDF.Key words : dermatopathology, diagnosis, discordance, melanocytic lesions, melanoma, observer variability, pathologist characteristics
Abbreviations used : CI, MPATH-Dx, OR
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| Funding sources: Supported by the National Cancer Institute (grants R01 CA151306 and R01 CA201376). |
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| Disclosure: Dr Barnhill had a financial relationship with Myriad Genetics outside of the submitted work, Dr Elder had financial relationships with Myriad Genetics and with SciBase outside of the submitted work, and Mr Longton had grants from Fred Hutchinson Cancer Research Center while this study was conducted. Drs Piepkorn, Nelson, Knezevich, Pepe, Carney, Titus, Onega, Tosteson, Weinstock, and Elmore have no conflicts of interest to disclose. |
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| The funding agency had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. |
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| Reprints not available from the authors. |
Vol 79 - N° 1
P. 52 - luglio 2018 Ritorno al numero
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