The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms
Gerardo Ferrara, Zsolt Argenyi, Giuseppe Argenziano, Rino Cerio, Lorenzo Cerroni, Arturo Di Blasi, Elisa A A Feudale, Caterina M Giorgio, Cesare Massone, Oscar Nappi, Carlo Tomasini, Carmelo Urso, Iris Zalaudek, Harald Kittler, H Peter Soyer, Gerardo Ferrara, Zsolt Argenyi, Giuseppe Argenziano, Rino Cerio, Lorenzo Cerroni, Arturo Di Blasi, Elisa A A Feudale, Caterina M Giorgio, Cesare Massone, Oscar Nappi, Carlo Tomasini, Carmelo Urso, Iris Zalaudek, Harald Kittler, H Peter Soyer
Abstract
Background: We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).
Methods: Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.
Findings: In D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23). Most diagnostic changes were in D2 (age/sex/location).
Interpretation: The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
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References
- Ferrara G, Argenziano G, Soyer HP, Corona R, Sera F, et al. Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions. An interdisciplinary study on 107 cases. Cancer. 2002;95:1094–1100.
- Corona R, Mele A, Amini M, De Rosa G, Coppola G, et al. Interobserver variability on the histopathologic diagnosis of cutaneous melanoma and other pigmented skin lesions. J Clin Oncol. 1996;14:1218–1223.
- Farmer ER, Gonin R, Hanna MP. Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists. Hum Pathol. 1996;27:528–531.
- Cerroni L, Kerl H. Tutorial on melanocytic lesions. Am J Dermatopathol. 2001;23:237–241.
- Lowes MA, Norris D, Whitfeld M. Benign melanocytic proliferative nodule within a congenital naevus. Australas J Dermatol. 2000;41:109–111.
- Drut R, Drut RM, Cohen M. Adnexal-centered giant congenital melanocyte nevus with extensive ganglioneuromatous component and trisomy 7. Pediatr Dev Pathol. 1999;2:473–477.
- Barnhill R. The Spitzoid lesion: the importance of atypical variants and risk assessment. Am J Dermatopathol. 2006;28:75–83.
- Weedon D. Lentigines, nevi and melanoma. In: Weedon D, editor. Skin Pathology. 2nd Ed. Edinburg: Churchill Livingstone; 2002. pp. 803–858.
- Soyer HP, Smolle J, Hoedl S, Pachernegg H, Kerl H. Surface microscopy: a new approach to the diagnosis of cutaneous pigmented tumors. Am J Dermatopathol. 1989;11:1–10.
- Argenziano G, Soyer HP, De Giorgi V, Piccolo D, Carli P, et al. Interactive atlas of dermoscopy (Book and CD-ROM) Milan: Edra Medical Publishing and New Media; 2000.
- Soyer HP, Kenet RO, Wolf IH, Kenet BJ, Cerroni L. Clinicopathological correlation of pigmented skin lesions using dermoscopy. Eur J Dermatol. 2000;10:22–28.
- Ferrara G, Argenziano G, Soyer P, Staibano S, Ruocco E, De Rosa G. Dermoscopic-pathologic correlation: an atlas of 15 cases. Clin Dermatol. 2002;20:228–235.
- Soyer HP, Massone C, Ferrara G, Argenziano G. Limitations of histopathologic analysis in the recognition of melanoma: a plea for a combined diagnostic approach of histopathologic and dermoscopic evaluation. Arch Dermatol. 2005;141:209–211.
- Argenziano G, Puig S, Zalaudek I, Sera F, Corona R, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol. 2006;24:1877–1882.
- Bauer J, Metzler G, Rassner G, Garbe C, Blum A. Dermatoscopy turns histopathologists's attention to the suspicious area in melanocytic lesions. Arch Dermatol. 2001;137:1338–1340.
- Zalaudek I, Argenziano G, Ferrara G, Soyer HP, Corona R, et al. Clinically equivocal melanocytic skin lesions withy features of regression: a dermoscopic-pathological study. Br J Dermatol. 2004;150:64–71.
- Ferrara G, Argenziano G, Cerroni L, Cusano F, Di Blasi A, et al. A pilot study on combined dermoscopic-pathological approach to the telediagnosis of melanocytic skin neoplasms. J Telemed Telecare. 2004;10:34–38.
- Ferrara G, Argenziano G, Soyer HP, Chimenti S, Di Blasi A, et al. The spectrum of Spitz nevi: a clinicopathologic study of 83 cases. Arch Dermatol. 2005;141:1381–1387.
- Ferrara G, Zalaudek, Argenziano G. Lentiginous melanoma: a distinctive clinicopathological entity. Histopathology. 2008;52:523–525.
- Shitabata PK. Do clinical histories submitted on biopsy requisition sheets bias the Pathologists? .
- Meghini C, Sebastiani F, Straccia U, Thanos C. A model of information retrieval based on a terminological logic. Proceedings of SIGIR-93, 16th ACM International Conference on Research and Development in Information Retrieval. Pittsburgh, PA. 1993:298–307.
- Cohen J. A coefficient of agreement for nominal scales. Educat Psychol Measur. 1960;20:37–46.
- Fleiss JL, Cohen J, Everitt BS. Large sample standard errors of kappa and weighted kappa. Psychol Bull. 1969;72:323–327.
- Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76:378–382.
- Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York: Wiley; 1981. pp. 2–28.
- Schreiber MH. The clinical history as a factor in roentgenogram interpretation. JAMA. 1963;185:399–401.
- Griscom NT. A suggestion: look at the images first, before you read the history. Radiology. 2002;223:9–10.
- Abbey LM, Kaugars GE, Gunsolley JC, Burns JC, Page DG, et al. The effect of the clinical information on the histopathologic diagnosis of oral epithelial dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:74–77.
- Raab SS, Oweity T, Hughes JH, Salomao BR, Kelley CM, et al. Effect of clinical history on diagnostic accuracy in the cytologic interpretation of bronchial brush specimens. Am J Clin Pathol. 2000;114:78–83.
- Loy CT, Irwig L. Accuracy of diagnostic tests read with and without clinical information. A systematic review. JAMA. 2004;292:1602–1609.
- Elder DE, Xu X. The approach to the patient with a difficult melanocytic lesion. Pathology. 2004;36:428–434.
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