Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation,Journal of the American Academy of Dermatology

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Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation
Journal of the American Academy of Dermatology ( IF 12.8 ) Pub Date : 2018-03-07 , DOI: 10.1016/j.jaad.2018.02.070
David E Elder ₁ , Michael W Piepkorn ₂ , Raymond L Barnhill ₃ , Gary M Longton ₄ , Heidi D Nelson ₅ , Stevan R Knezevich ₆ , Margaret S Pepe ₄ , Patricia A Carney ₇ , Linda J Titus ₈ , Tracy Onega ₉ , Anna N A Tosteson ₁₀ , Martin A Weinstock ₁₁ , Joann G Elmore ₁₂

Affiliation

Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Dermatopathology Northwest, Bellevue, Washington.
Department of Pathology, Institut Curie, Paris, France; University of Paris Descartes, Paris, France.
Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon.
Pathology Associates, Clovis, California.
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
Department of Epidemiology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire.
Department of Biomedical Data Science, Department of Epidemiology, Norris Cotton Cancer Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire; Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire.
Center for Dermatoepidemiology, VA Medical Center, Providence Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island; Department of Epidemiology, Brown University, Providence, Rhode Island.
Department of Medicine, University of Washington School of Medicine, Seattle, Washington.

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.

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