Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center

Niebling, Maarten G.; Haydu, Lauren E.; Karim, Rooshdiya Z.; Thompson, John F.; Scolyer, Richard A.

doi:10.1245/s10434-014-3682-x

Cited by 36 publications

(45 citation statements)

References 33 publications

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“…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

343

421

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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.

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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

343

421

View full text Add to dashboard Cite

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“…1,3 Moreover, epidemiologic research regarding melanocytic lesions and associated outcomes has been limited by diagnostic inconsistency. Treatment suggestions in pathology reports may help resolve this ambiguity.…”

Section: Introductionmentioning

confidence: 99%

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

Lott

Elmore

Zhao

et al. 2016

Journal of the American Academy of Dermatology

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Background Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care. Objective To evaluate the Melanoma Pathology Assessment and Treatment Hierarchy (MPATH-Dx) scheme, a five-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 provided, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Inter-rater agreement [95% CI] and correlation between MPATH-Dx categorization and treatment suggestions were evaluated. Results Most participants were dermatopathologists (n=12), age ≥50 years (n=12), male (n=9), US-based (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 following MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 [0.68, 0.71] and 0.72 [0.71, 0.73], respectively, while correlation between MPATH-Dx categorization and treatment suggestions was 0.91. Limitations Small sample size of experienced pathologists in a testing situation. Conclusion Varying diagnostic nomenclature can be consistently 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.

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“…e-mail: susan.davies@addenbrookes.nhs.uk cases reported by general pathologists found clinically significant discrepancies in only 1.4% of reviews, 12 but an expert review of melanoma diagnoses in patients referred to a specialist centre identified clinically significant diagnostic differences in 5% of cases, discrepancies in staging in an additional 22%, and consequently changes in management in 20% of patients. 13 It is standard UK practice for patients with a cancer diagnosis to be discussed at a multidisciplinary team (MDT) meeting, involving a review of any histopathology, prior to deciding on management. Recent studies in a range of diagnoses, including prostate cancer, breast cancer, lymphoma and melanoma, have demonstrated the value of this, with discrepancy rates varying from 6% to 57% [13][14][15][16][17] and involving the malignant diagnosis itself, or the classification, stage or grade of the tumour.…”

Section: Introductionmentioning

confidence: 99%

“…13 It is standard UK practice for patients with a cancer diagnosis to be discussed at a multidisciplinary team (MDT) meeting, involving a review of any histopathology, prior to deciding on management. Recent studies in a range of diagnoses, including prostate cancer, breast cancer, lymphoma and melanoma, have demonstrated the value of this, with discrepancy rates varying from 6% to 57% [13][14][15][16][17] and involving the malignant diagnosis itself, or the classification, stage or grade of the tumour. Changes in patient management were predicted in 6-22% of all cases reviewed.…”

Section: Introductionmentioning

confidence: 99%

Any value in a specialist review of liver biopsies? Conclusions of a 4‐year review

et al. 2016

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Clinically significant differences in liver biopsy interpretation between local pathologists and subspecialists are common. Diagnoses with frequent discrepancies, such as biliary disease, may benefit from a specialist review as standard when diagnosed initially, while cases requiring specialist advice from disease subgroups where discrepancies are less common, such as chronic viral hepatitis, could be selected during the clinicopathological conference process.

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Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center

Abstract: Diagnosis, AJCC T classification, and treatment recommendations often change after pathology review by specialist melanoma pathologists. We recommend pathology review be considered for all patients attending specialist melanoma treatment centers.

Cited by 36 publications

References 33 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

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

Any value in a specialist review of liver biopsies? Conclusions of a 4‐year review

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