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

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:75

Article

Lott, Jason P.¹  Elmore, Joann G.^2,23  Zhao, Ge A.³  Knezevich, Stevan R.⁴  Frederick, Paul D.²  Reisch, Lisa M.²  Chu, Emily Y.⁵  Cook, Martin G.⁷  Duncan, Lyn M.⁸  Elenitsas, Rosalie⁵  Gerami, Pedram^9,14  Landman, Gilles¹⁰  Lowe, Lori¹¹  Messina, Jane L.^12,13  Mihm, Martin C.^15,16  van den Oord, Joost J.¹⁷  Rabkin, Michael S.¹⁸  Schmidt, Birgitta^16,19  Shea, Christopher R.²⁰  Yun, Sook Jung²¹  Xu, George X.⁶  Piepkorn, Michael W.³  Elder, David E.⁶  Barnhill, Raymond L.^22,23 

[1] Cornell Scott Hill Hlth Ctr, New Haven, CT USA

[2] Univ Washington, Sch Med, Dept Internal Med, Seattle, WA 98195 USA

[3] Univ Washington, Sch Med, Div Dermatol, Seattle, WA 98195 USA

[4] Pathol Associates Inc, Clovis, CA USA

[5] Univ Penn, Perelman Sch Med, Dept Dermatol, Philadelphia, PA 19104 USA

[6] Univ Penn, Perelman Sch Med, Dept Pathol & Lab Med, Philadelphia, PA 19104 USA

[7] Univ Surrey, Div Clin Med, Guildford GU2 5XH, Surrey, England

[8] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA

[9] Northwestern Univ, Feinberg Sch Med, Dept Dermatol, Chicago, IL 60611 USA

[10] Univ Fed Sao Paulo, Escola Paulista Med, Dept Pathol, Sao Paulo, Brazil

[11] Univ Michigan Hosp & Hlth Syst, Dept Pathol & Dermatol, Ann Arbor, MI USA

[12] Univ S Florida, Morsani Coll Med, Dept Anat Pathol, Moffitt Ctr, Tampa, FL 33620 USA

[13] Univ S Florida, Morsani Coll Med, Dept Cutaneous Oncol, Moffitt Ctr, Tampa, FL 33620 USA

[14] Univ S Florida, Morsani Coll Med, Dept Pathol & Cell Biol, Tampa, FL 33620 USA

[15] Brigham & Womens Hosp, Dept Dermatol, 75 Francis St, Boston, MA 02115 USA

[16] Harvard Med Sch, Boston, MA USA

[17] Katholieke Univ Leuven, Univ Hosp, Dept Pathol, Leuven, Belgium

[18] Rabkin Dermatopathol Lab PC, Tarentum, PA USA

[19] Boston Childrens Hosp, Dept Pathol, Boston, MA USA

[20] Univ Chicago Med, Dermatol Sect, Chicago, IL USA

[21] Chonnam Natl Univ, Sch Med, Dept Dermatol, Gwangju, South Korea

[22] Univ Paris 05, Dept Pathol, Inst Curie, Paris, France

[23] Univ Paris 05, Fac Med, Paris, France

关键词: classification;    diagnosis;    dysplastic nevus;    melanoma;    Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis;    nevus;    pathology;    variability;    variation;   

DOI  :  10.1016/j.jaad.2016.04.052

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

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