Kathleen F Kerr1, Gary M Longton2, Lisa M Reisch1, Andrea C Radick1, Megan M Eguchi3, Hannah L Shucard1, Margaret S Pepe2, Michael W Piepkorn4,5, David E Elder6, Raymond L Barnhill7,8, Joann G Elmore3. 1. Department of Biostatistics, University of Washington, Seattle, WA, USA. 2. Program in Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 3. Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA. 4. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 5. Dermatopathology Northwest, Bellevue, WA, USA. 6. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 7. Department of Translational Research, Institut Curie, Paris, France. 8. UFR of Medicine, University of Paris, Paris, France.
Abstract
BACKGROUND: Previous studies of second opinions in the diagnosis of melanocytic skin lesions have examined blinded second opinions, which do not reflect usual clinical practice. The current study, conducted in the USA, investigated both blinded and nonblinded second opinions for their impact on diagnostic accuracy. METHODS: In total, 100 melanocytic skin biopsy cases, ranging from benign to invasive melanoma, were interpreted by 74 dermatopathologists. Subsequently, 151 dermatopathologists performed nonblinded second and third reviews. We compared the accuracy of single reviewers, second opinions obtained from independent, blinded reviewers and second opinions obtained from sequential, nonblinded reviewers. Accuracy was defined with respect to a consensus reference diagnosis. RESULTS: The mean case-level diagnostic accuracy of single reviewers was 65.3% (95% CI 63.4-67.2%). Second opinions arising from sequential, nonblinded reviewers significantly improved accuracy to 69.9% (95% CI 68.0-71.7%; P < 0.001). Similarly, second opinions arising from blinded reviewers improved upon the accuracy of single reviewers (69.2%; 95% CI 68.0-71.7%). Nonblinded reviewers were more likely than blinded reviewers to give diagnoses in the same diagnostic classes as the first diagnosis. Nonblinded reviewers tended to be more confident when they agreed with previous reviewers, even with inaccurate diagnoses. CONCLUSION: We found that both blinded and nonblinded second reviewers offered a similar modest improvement in diagnostic accuracy compared with single reviewers. Obtaining second opinions with knowledge of previous reviews tends to generate agreement among reviews, and may generate unwarranted confidence in an inaccurate diagnosis. Combining aspects of both blinded and nonblinded review in practice may leverage the advantages while mitigating the disadvantages of each approach. Specifically, a second pathologist could give an initial diagnosis blinded to the results of the first pathologist, with subsequent nonblinded discussion between the two pathologists if their diagnoses differ.
BACKGROUND: Previous studies of second opinions in the diagnosis of melanocytic skin lesions have examined blinded second opinions, which do not reflect usual clinical practice. The current study, conducted in the USA, investigated both blinded and nonblinded second opinions for their impact on diagnostic accuracy. METHODS: In total, 100 melanocytic skin biopsy cases, ranging from benign to invasive melanoma, were interpreted by 74 dermatopathologists. Subsequently, 151 dermatopathologists performed nonblinded second and third reviews. We compared the accuracy of single reviewers, second opinions obtained from independent, blinded reviewers and second opinions obtained from sequential, nonblinded reviewers. Accuracy was defined with respect to a consensus reference diagnosis. RESULTS: The mean case-level diagnostic accuracy of single reviewers was 65.3% (95% CI 63.4-67.2%). Second opinions arising from sequential, nonblinded reviewers significantly improved accuracy to 69.9% (95% CI 68.0-71.7%; P < 0.001). Similarly, second opinions arising from blinded reviewers improved upon the accuracy of single reviewers (69.2%; 95% CI 68.0-71.7%). Nonblinded reviewers were more likely than blinded reviewers to give diagnoses in the same diagnostic classes as the first diagnosis. Nonblinded reviewers tended to be more confident when they agreed with previous reviewers, even with inaccurate diagnoses. CONCLUSION: We found that both blinded and nonblinded second reviewers offered a similar modest improvement in diagnostic accuracy compared with single reviewers. Obtaining second opinions with knowledge of previous reviews tends to generate agreement among reviews, and may generate unwarranted confidence in an inaccurate diagnosis. Combining aspects of both blinded and nonblinded review in practice may leverage the advantages while mitigating the disadvantages of each approach. Specifically, a second pathologist could give an initial diagnosis blinded to the results of the first pathologist, with subsequent nonblinded discussion between the two pathologists if their diagnoses differ.
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: Berta M Geller; Paul D Frederick; Stevan R Knezevich; Jason P Lott; Heidi D Nelson; Linda J Titus; Patricia A Carney; Anna N A Tosteson; Tracy L Onega; Raymond L Barnhill; Martin A Weinstock; David E Elder; Michael W Piepkorn; Joann G Elmore Journal: Dermatol Surg Date: 2018-02 Impact factor: 3.398
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: Anna N A Tosteson; Stephanie Tapp; Linda J Titus; Heidi D Nelson; Gary M Longton; Mackenzie Bronson; Margaret Pepe; Patricia A Carney; Tracy Onega; Michael W Piepkorn; Stevan R Knezevich; Raymond Barnhill; Martin A Weinstock; David E Elder; Joann G Elmore Journal: JAMA Dermatol Date: 2021-09-01 Impact factor: 11.816
Authors: Joann G Elmore; Anna Na Tosteson; Margaret S Pepe; Gary M Longton; Heidi D Nelson; Berta Geller; Patricia A Carney; Tracy Onega; Kimberly H Allison; Sara L Jackson; Donald L Weaver Journal: BMJ Date: 2016-06-22