Tracy Onega1,2,3, Raymond L Barnhill4, Michael W Piepkorn5,6, Gary M Longton7, David E Elder8, Martin A Weinstock9,10, Stevan R Knezevich11, Lisa M Reisch12, Patricia A Carney13, Heidi D Nelson14,15,16, Andrea C Radick12, Joann G Elmore17. 1. Departments of Medicine and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire. 2. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. 3. Norris Cotton Cancer Center, Lebanon, New Hampshire. 4. Department of Pathology, Institut Curie, Paris Sciences and Lettres Research University, and Faculty of Medicine University of Paris Descartes, Paris, France. 5. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle. 6. Dermatopathology Northwest, Bellevue, Washington. 7. Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington. 8. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia. 9. Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island. 10. Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island. 11. Pathology Associates, Clovis, California. 12. Department of Medicine, University of Washington School of Medicine, Seattle. 13. Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland. 14. Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland. 15. Department of Medicine, School of Medicine, Oregon Health & Science University, Portland. 16. Providence Cancer Center, Providence Health and Services, Portland, Oregon. 17. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Abstract
Importance: Use of digital whole-slide imaging (WSI) for dermatopathology in general has been noted to be similar to traditional microscopy (TM); however, concern has been noted that WSI is inferior for interpretation of melanocytic lesions. Since approximately 1 of every 4 skin biopsies is of a melanocytic lesion, the use of WSI requires verification before use in clinical practice. Objective: To compare pathologists' accuracy and reproducibility in diagnosing melanocytic lesions using Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) categories when analyzing by TM vs WSI. Design, Setting, and Participants: A total of 87 pathologists in community-based and academic settings from 10 US states were randomized with stratification based on clinical experience to interpret in TM format 180 skin biopsy cases of melanocytic lesions, including 90 invasive melanoma, divided into 5 sets of 36 cases (phase 1). The pathologists were then randomized via stratified permuted block randomization with block size 2 to interpret cases in either TM (n = 46) or WSI format (n = 41), with each pathologist interpreting the same 36 cases on 2 separate occasions (phase 2). Diagnoses were categorized as MPATH-Dx categories I through V, with I indicating the least severe and V the most severe. Main Outcomes and Measures: Accuracy with respect to a consensus reference diagnosis and the reproducibility of repeated interpretations of the same cases. Results:Of the 87 pathologists in the study, 46% (40) were women and the mean (SD) age was 50.7 (10.2) years. Except for class III melanocytic lesions, the diagnostic categories showed no significant differences in diagnostic accuracy between TM and WSI interpretation. Discordance was lower among class III lesions for the TM interpretation arm (51%; 95% CI, 46%-57%) than for the WSI arm (61%; 95% CI, 53%-69%) (P = .05). This difference is likely to have clinical significance, because 6% of TM vs 11% of WSI class III lesions were interpreted as invasive melanoma. Reproducibility was similar between the traditional and digital formats overall (66.4%; 95% CI, 63.3%-69.3%; and 62.7%; 95% CI, 59.5%-65.7%, respectively), and for all classes, although class III showed a nonsignificant lower intraobserver agreement for digital. Significantly more mitotic figures were detected with TM compared with WSI: mean (SD) TM, 6.72 (2.89); WSI, 5.84 (2.56); P = .002. Conclusions and Relevance: Interpretive accuracy for melanocytic lesions was similar for WSI and TM slides except for class III lesions. We found no clinically meaningful differences in reproducibility for any of the diagnostic classes.
RCT Entities:
Importance: Use of digital whole-slide imaging (WSI) for dermatopathology in general has been noted to be similar to traditional microscopy (TM); however, concern has been noted that WSI is inferior for interpretation of melanocytic lesions. Since approximately 1 of every 4 skin biopsies is of a melanocytic lesion, the use of WSI requires verification before use in clinical practice. Objective: To compare pathologists' accuracy and reproducibility in diagnosing melanocytic lesions using Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) categories when analyzing by TM vs WSI. Design, Setting, and Participants: A total of 87 pathologists in community-based and academic settings from 10 US states were randomized with stratification based on clinical experience to interpret in TM format 180 skin biopsy cases of melanocytic lesions, including 90 invasive melanoma, divided into 5 sets of 36 cases (phase 1). The pathologists were then randomized via stratified permuted block randomization with block size 2 to interpret cases in either TM (n = 46) or WSI format (n = 41), with each pathologist interpreting the same 36 cases on 2 separate occasions (phase 2). Diagnoses were categorized as MPATH-Dx categories I through V, with I indicating the least severe and V the most severe. Main Outcomes and Measures: Accuracy with respect to a consensus reference diagnosis and the reproducibility of repeated interpretations of the same cases. Results: Of the 87 pathologists in the study, 46% (40) were women and the mean (SD) age was 50.7 (10.2) years. Except for class III melanocytic lesions, the diagnostic categories showed no significant differences in diagnostic accuracy between TM and WSI interpretation. Discordance was lower among class III lesions for the TM interpretation arm (51%; 95% CI, 46%-57%) than for the WSI arm (61%; 95% CI, 53%-69%) (P = .05). This difference is likely to have clinical significance, because 6% of TM vs 11% of WSI class III lesions were interpreted as invasive melanoma. Reproducibility was similar between the traditional and digital formats overall (66.4%; 95% CI, 63.3%-69.3%; and 62.7%; 95% CI, 59.5%-65.7%, respectively), and for all classes, although class III showed a nonsignificant lower intraobserver agreement for digital. Significantly more mitotic figures were detected with TM compared with WSI: mean (SD) TM, 6.72 (2.89); WSI, 5.84 (2.56); P = .002. Conclusions and Relevance: Interpretive accuracy for melanocytic lesions was similar for WSI and TM slides except for class III lesions. We found no clinically meaningful differences in reproducibility for any of the diagnostic classes.
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: Thomas W Bauer; Lynn Schoenfield; Renee J Slaw; Lisa Yerian; Zhiyuan Sun; Walter H Henricks Journal: Arch Pathol Lab Med Date: 2013-01-16 Impact factor: 5.534
Authors: Patricia A Carney; Lisa M Reisch; Michael W Piepkorn; Raymond L Barnhill; David E Elder; Stevan Knezevich; Berta M Geller; Gary Longton; Joann G Elmore Journal: J Cutan Pathol Date: 2016-07-01 Impact factor: 1.587
Authors: Michael N Kent; Thomas G Olsen; Theresa A Feeser; Katherine C Tesno; John C Moad; Michael P Conroy; Mary Jo Kendrick; Sean R Stephenson; Michael R Murchland; Ayesha U Khan; Elizabeth A Peacock; Alexa Brumfiel; Michael A Bottomley Journal: JAMA Dermatol Date: 2017-12-01 Impact factor: 10.282
Authors: Joann G Elmore; Gary M Longton; Margaret S Pepe; Patricia A Carney; Heidi D Nelson; Kimberly H Allison; Berta M Geller; Tracy Onega; Anna N A Tosteson; Ezgi Mercan; Linda G Shapiro; Tad T Brunyé; Thomas R Morgan; Donald L Weaver Journal: J Pathol Inform Date: 2017-03-10
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Authors: Fatemeh Ghezloo; Pin-Chieh Wang; Kathleen F Kerr; Tad T Brunyé; Trafton Drew; Oliver H Chang; Lisa M Reisch; Linda G Shapiro; Joann G Elmore Journal: J Pathol Inform Date: 2022-05-21
Authors: Michael W Piepkorn; Gary M Longton; Lisa M Reisch; David E Elder; Margaret S Pepe; Kathleen F Kerr; Anna N A Tosteson; Heidi D Nelson; Stevan Knezevich; Andrea Radick; Hannah Shucard; Tracy Onega; Patricia A Carney; Joann G Elmore; Raymond L Barnhill Journal: JAMA Netw Open Date: 2019-10-02
Authors: Yannick Van Herck; Asier Antoranz; Madhavi Dipak Andhari; Giorgia Milli; Oliver Bechter; Frederik De Smet; Francesca Maria Bosisio Journal: Front Oncol Date: 2021-03-29 Impact factor: 6.244
Authors: Ian Katz; Blake O'Brien; Simon Clark; Curtis T Thompson; Brian Schapiro; Anthony Azzi; Alister Lilleyman; Terry Boyle; Lore Jane L Espartero; Miko Yamada; Tarl W Prow Journal: JAMA Netw Open Date: 2021-12-01