Patricia A Carney1, Lisa M Reisch2, Michael W Piepkorn3,4, Raymond L Barnhill5,6, David E Elder7, Stevan Knezevich8,9,10, Berta M Geller11, Gary Longton12, Joann G Elmore13. 1. Professor of Family Medicine and of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA. carneyp@ohsu.edu. 2. Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA. 3. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 4. Dermatopathology Northwest, Bellevue, WA, USA. 5. Department of Pathology, University of California, Los Angeles, CA, USA. 6. Institut Curie and University of Paris Réne Descartes, Paris, France. 7. Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA. 8. Department of Pathology, The Veterans Affairs Medical Center, Seattle, WA, USA. 9. Assistant Professor of Pathology, University of Washington, Seattle, WA, USA. 10. Pathology Associates, Clovis, CA, USA. 11. Department of Family Medicine, University of Vermont, Burlington, VT, USA. 12. Fred Hutchison Cancer Research Center, Seattle, WA, USA. 13. Professor of Internal Medicine, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: To understand the sophisticated nature of coming to consensus when diagnosing complex melanocytic lesions among a panel of experienced dermatopathologists. METHODS:A total of 240 melanocytic lesions were assessed independently by three experienced dermatopathologists with their diagnoses mapped into one of five Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-DX) categories: (I) nevus/mild atypia, (II) moderate atypia, (III) severe atypia/melanoma in situ, (IV) T1a invasive melanoma and (V) ≥ T1b invasive melanoma. The dermatopathologists then discussed the cases, using a modified Delphi method to facilitated consensus building for cases with discordant diagnoses. RESULTS: For most cases, a majority of interpretations (two or three of three) agreed with the consensus diagnosis in 95% of Category I, 64% of Category II, 84% of Category III, 88% for Category IV and 100% of Category V cases. Disagreements were typically due to diagnostic threshold differences (64.5%), differing contents on slides even though the slides were sequential cuts (18.5%), and missed findings (15.3%). Disagreements were resolved via discussion of histopathologic features and their significance while reviewing the slides using a multi-headed microscope, considering treatment recommendations, citing existing literature, reviewing additional slides for a case, and choosing a provisional/borderline diagnosis to capture diverse opinions. All experienced pathologists participating in this study reported that the process of coming to consensus was challenging for borderline cases and may have represented compromise rather than consensus. They also reported the process changed their approaches to diagnosing complex melanocytic lesions. CONCLUSIONS: The most frequent reason for disagreement of experienced dermatopathologists was differences in diagnostic thresholds related to observer viewpoints. A range of approaches was needed to come to consensus, and this may guide pathology groups who do not currently hold consensus conferences.
RCT Entities:
OBJECTIVE: To understand the sophisticated nature of coming to consensus when diagnosing complex melanocytic lesions among a panel of experienced dermatopathologists. METHODS: A total of 240 melanocytic lesions were assessed independently by three experienced dermatopathologists with their diagnoses mapped into one of five Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-DX) categories: (I) nevus/mild atypia, (II) moderate atypia, (III) severe atypia/melanoma in situ, (IV) T1a invasive melanoma and (V) ≥ T1b invasive melanoma. The dermatopathologists then discussed the cases, using a modified Delphi method to facilitated consensus building for cases with discordant diagnoses. RESULTS: For most cases, a majority of interpretations (two or three of three) agreed with the consensus diagnosis in 95% of Category I, 64% of Category II, 84% of Category III, 88% for Category IV and 100% of Category V cases. Disagreements were typically due to diagnostic threshold differences (64.5%), differing contents on slides even though the slides were sequential cuts (18.5%), and missed findings (15.3%). Disagreements were resolved via discussion of histopathologic features and their significance while reviewing the slides using a multi-headed microscope, considering treatment recommendations, citing existing literature, reviewing additional slides for a case, and choosing a provisional/borderline diagnosis to capture diverse opinions. All experienced pathologists participating in this study reported that the process of coming to consensus was challenging for borderline cases and may have represented compromise rather than consensus. They also reported the process changed their approaches to diagnosing complex melanocytic lesions. CONCLUSIONS: The most frequent reason for disagreement of experienced dermatopathologists was differences in diagnostic thresholds related to observer viewpoints. A range of approaches was needed to come to consensus, and this may guide pathology groups who do not currently hold consensus conferences.
Authors: Michael W Piepkorn; Raymond L Barnhill; David E Elder; Stevan R Knezevich; Patricia A Carney; Lisa M Reisch; Joann G Elmore Journal: J Am Acad Dermatol Date: 2013-10-28 Impact factor: 11.527
Authors: R P Braun; D Gutkowicz-Krusin; H Rabinovitz; A Cognetta; R Hofmann-Wellenhof; V Ahlgrimm-Siess; D Polsky; M Oliviero; I Kolm; P Googe; R King; V G Prieto; L French; A Marghoob; M Mihm Journal: Dermatology Date: 2012-03-20 Impact factor: 5.366
Authors: Stevan R Knezevich; Raymond L Barnhill; David E Elder; Michael W Piepkorn; Lisa M Reisch; Gaia Pocobelli; Patricia A Carney; Joann G Elmore Journal: J Am Acad Dermatol Date: 2014-09-16 Impact factor: 11.527
Authors: Gerardo Ferrara; Giuseppe Argenziano; H Peter Soyer; Rosamaria Corona; Francesco Sera; Bruno Brunetti; Lorenzo Cerroni; Sergio Chimenti; Laila El Shabrawi-Caelen; Angela Ferrari; Rainer Hofmann-Wellenhof; Steven Kaddu; Domenico Piccolo; Massimiliano Scalvenzi; Stefania Staibano; Ingrid H Wolf; Gaetano De Rosa Journal: Cancer Date: 2002-09-01 Impact factor: 6.860
Authors: David E Elder; Michael W Piepkorn; Raymond L Barnhill; Gary M Longton; Heidi D Nelson; Stevan R Knezevich; Margaret S Pepe; Patricia A Carney; Linda J Titus; Tracy Onega; Anna N A Tosteson; Martin A Weinstock; Joann G Elmore Journal: J Am Acad Dermatol Date: 2018-03-07 Impact factor: 11.527
Authors: Tad T Brunyé; Trafton Drew; Manob Jyoti Saikia; Kathleen F Kerr; Megan M Eguchi; Annie C Lee; Caitlin May; David E Elder; Joann G Elmore Journal: Vis cogn Date: 2021-06-16
Authors: Kathleen F Kerr; Gary M Longton; Lisa M Reisch; Andrea C Radick; Megan M Eguchi; Hannah L Shucard; Margaret S Pepe; Michael W Piepkorn; David E Elder; Raymond L Barnhill; Joann G Elmore Journal: Clin Exp Dermatol Date: 2022-06-22 Impact factor: 4.481
Authors: Tracy Onega; Raymond L Barnhill; Michael W Piepkorn; Gary M Longton; David E Elder; Martin A Weinstock; Stevan R Knezevich; Lisa M Reisch; Patricia A Carney; Heidi D Nelson; Andrea C Radick; Joann G Elmore Journal: JAMA Dermatol Date: 2018-10-01 Impact factor: 10.282
Authors: Ge Zhao; Kachiu C Lee; Sue Peacock; Lisa M Reisch; Stevan R Knezevich; David E Elder; Michael W Piepkorn; Joann G Elmore; Raymond L Barnhill Journal: J Cutan Pathol Date: 2016-10-28 Impact factor: 1.587
Authors: Patricia A Carney; Paul D Frederick; Lisa M Reisch; Linda Titus; Stevan R Knezevich; Martin A Weinstock; Michael W Piepkorn; Raymond L Barnhill; David E Elder; Donald L Weaver; Joann G Elmore Journal: J Cutan Pathol Date: 2018-04-26 Impact factor: 1.587
Authors: Caitlin J May; Michael W Piepkorn; Stevan R Knezevich; David E Elder; Raymond L Barnhill; Annie C Lee; Martiniano J Flores; Kathleen F Kerr; Lisa M Reisch; Joann G Elmore Journal: J Cutan Pathol Date: 2020-07-17 Impact factor: 1.587
Authors: Laura A Taylor; Megan M Eguchi; Lisa M Reisch; Andrea C Radick; Hannah Shucard; Kathleen F Kerr; Michael W Piepkorn; Stevan R Knezevich; David E Elder; Raymond L Barnhill; Joann G Elmore Journal: Cancer Date: 2021-05-04 Impact factor: 6.860
Authors: Mustufa A Jafry; Sue Peacock; Andrea C Radick; Hannah L Shucard; Lisa M Reisch; Michael W Piepkorn; Stevan R Knezevich; Martin A Weinstock; Raymond L Barnhill; David E Elder; Kathleen F Kerr; Joann G Elmore Journal: J Am Acad Dermatol Date: 2019-12-17 Impact factor: 11.527
Authors: Rami N Al-Rohil; Jessica L Moore; Nathan Heath Patterson; Sarah Nicholson; Nico Verbeeck; Marc Claesen; Jameelah Z Muhammad; Richard M Caprioli; Jeremy L Norris; Sara Kantrow; Margaret Compton; Jason Robbins; Ahmed K Alomari Journal: J Cutan Pathol Date: 2021-07-02 Impact factor: 1.587