Caitlin J May1,2, Michael W Piepkorn1,2, Stevan R Knezevich3, David E Elder4, Raymond L Barnhill5, Annie C Lee6, Martiniano J Flores7, Kathleen F Kerr8, Lisa M Reisch8, Joann G Elmore6,9. 1. Dermatopathology Northwest, Bellevue, Washington, USA. 2. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA. 3. Pathology Associates, Clovis, California, USA. 4. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Department of Translational Research Institut Curie, Paris Sciences and Lettres Research University; Faculty of Medicine, University of Paris Descartes, Paris, France. 6. Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA. 7. Edwards Lifesciences, Irvine, California, USA. 8. Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA. 9. Division of Dermatology, UCLA David Geffen School of Medicine, Los Angeles, California, USA.
Abstract
BACKGROUND: Melanocytic tumors are often challenging and constitute almost one in four skin biopsies. Immunohistochemical (IHC) studies may assist diagnosis; however, indications for their use are not standardized. METHODS: A test set of 240 skin biopsies of melanocytic tumors was examined by 187 pathologists from 10 US states, interpreting 48 cases in Phase I and either 36 or 48 cases in Phase II. Participant and diagnosis characteristics were compared between those who reported they would have ordered, or who would have not ordered IHC on individual cases. Intraobserver analysis examined consistency in the intent to order when pathologists interpreted the same cases on two occasions. RESULTS: Of 187 participants interpreting 48 cases each, 21 (11%) did not request IHC tests for any case, 85 (45%) requested testing for 1 to 6 cases, and 81 (43%) requested testing for ≥6 cases. Of 240 cases, 229 had at least one participant requesting testing. Only 2 out of 240 cases had more than 50% of participants requesting testing. Increased utilization of testing was associated with younger age of pathologist, board-certification in dermatopathology, low confidence in diagnosis, and lesions in intermediate MPATH-Dx classes 2 to 4. The median intraobserver concordance for requesting tests among 72 participants interpreting the same 48 cases in Phases I and II was 81% (IQR 73%-90%) and the median Kappa statistic was 0.20 (IQR 0.00, 0.39). CONCLUSION: Substantial variability exists among pathologists in utilizing IHC.
BACKGROUND: Melanocytic tumors are often challenging and constitute almost one in four skin biopsies. Immunohistochemical (IHC) studies may assist diagnosis; however, indications for their use are not standardized. METHODS: A test set of 240 skin biopsies of melanocytic tumors was examined by 187 pathologists from 10 US states, interpreting 48 cases in Phase I and either 36 or 48 cases in Phase II. Participant and diagnosis characteristics were compared between those who reported they would have ordered, or who would have not ordered IHC on individual cases. Intraobserver analysis examined consistency in the intent to order when pathologists interpreted the same cases on two occasions. RESULTS: Of 187 participants interpreting 48 cases each, 21 (11%) did not request IHC tests for any case, 85 (45%) requested testing for 1 to 6 cases, and 81 (43%) requested testing for ≥6 cases. Of 240 cases, 229 had at least one participant requesting testing. Only 2 out of 240 cases had more than 50% of participants requesting testing. Increased utilization of testing was associated with younger age of pathologist, board-certification in dermatopathology, low confidence in diagnosis, and lesions in intermediate MPATH-Dx classes 2 to 4. The median intraobserver concordance for requesting tests among 72 participants interpreting the same 48 cases in Phases I and II was 81% (IQR 73%-90%) and the median Kappa statistic was 0.20 (IQR 0.00, 0.39). CONCLUSION: Substantial variability exists among pathologists in utilizing IHC.
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: Jason P Lott; Denise M Boudreau; Ray L Barnhill; Martin A Weinstock; Eleanor Knopp; Michael W Piepkorn; David E Elder; Steven R Knezevich; Andrew Baer; Anna N A Tosteson; Joann G Elmore Journal: JAMA Dermatol Date: 2018-01-01 Impact factor: 10.282
Authors: Linda J Titus; Lisa M Reisch; Anna N A Tosteson; Heidi D Nelson; Paul D Frederick; Patricia A Carney; Raymond L Barnhill; David E Elder; Martin A Weinstock; Michael W Piepkorn; Joann G Elmore Journal: Am J Clin Pathol Date: 2018-08-30 Impact factor: 2.493