Achieving consensus for the histopathologic diagnosis of melanocytic lesions: use of the modified Delphi method

Patricia (Patty) Carney, Lisa M. Reisch, Michael W. Piepkorn, Raymond L. Barnhill, David E. Elder, Stevan Knezevich, Berta M. Geller, Gary Longton, Joann G. Elmore

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)830-837
Number of pages8
JournalJournal of Cutaneous Pathology
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Melanoma
Pathology
Nevus
Therapeutics
Pathologists

Keywords

  • dermatopathology
  • interpretive accuracy
  • melanocytic lesions

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Dermatology

Cite this

Carney, P. P., Reisch, L. M., Piepkorn, M. W., Barnhill, R. L., Elder, D. E., Knezevich, S., ... Elmore, J. G. (2016). Achieving consensus for the histopathologic diagnosis of melanocytic lesions: use of the modified Delphi method. Journal of Cutaneous Pathology, 43(10), 830-837. https://doi.org/10.1111/cup.12751

Achieving consensus for the histopathologic diagnosis of melanocytic lesions : use of the modified Delphi method. / Carney, Patricia (Patty); Reisch, Lisa M.; Piepkorn, Michael W.; Barnhill, Raymond L.; Elder, David E.; Knezevich, Stevan; Geller, Berta M.; Longton, Gary; Elmore, Joann G.

In: Journal of Cutaneous Pathology, Vol. 43, No. 10, 01.10.2016, p. 830-837.

Research output: Contribution to journalArticle

Carney, PP, Reisch, LM, Piepkorn, MW, Barnhill, RL, Elder, DE, Knezevich, S, Geller, BM, Longton, G & Elmore, JG 2016, 'Achieving consensus for the histopathologic diagnosis of melanocytic lesions: use of the modified Delphi method', Journal of Cutaneous Pathology, vol. 43, no. 10, pp. 830-837. https://doi.org/10.1111/cup.12751
Carney, Patricia (Patty) ; Reisch, Lisa M. ; Piepkorn, Michael W. ; Barnhill, Raymond L. ; Elder, David E. ; Knezevich, Stevan ; Geller, Berta M. ; Longton, Gary ; Elmore, Joann G. / Achieving consensus for the histopathologic diagnosis of melanocytic lesions : use of the modified Delphi method. In: Journal of Cutaneous Pathology. 2016 ; Vol. 43, No. 10. pp. 830-837.
@article{aaa2c1bbdc5e4e82815016e980a54d78,
title = "Achieving consensus for the histopathologic diagnosis of melanocytic lesions: use of the modified Delphi method",
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.",
keywords = "dermatopathology, interpretive accuracy, melanocytic lesions",
author = "Carney, {Patricia (Patty)} and Reisch, {Lisa M.} and Piepkorn, {Michael W.} and Barnhill, {Raymond L.} and Elder, {David E.} and Stevan Knezevich and Geller, {Berta M.} and Gary Longton and Elmore, {Joann G.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1111/cup.12751",
language = "English (US)",
volume = "43",
pages = "830--837",
journal = "Journal of Cutaneous Pathology",
issn = "0303-6987",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Achieving consensus for the histopathologic diagnosis of melanocytic lesions

T2 - use of the modified Delphi method

AU - Carney, Patricia (Patty)

AU - Reisch, Lisa M.

AU - Piepkorn, Michael W.

AU - Barnhill, Raymond L.

AU - Elder, David E.

AU - Knezevich, Stevan

AU - Geller, Berta M.

AU - Longton, Gary

AU - Elmore, Joann G.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

KW - dermatopathology

KW - interpretive accuracy

KW - melanocytic lesions

UR - http://www.scopus.com/inward/record.url?scp=84988359724&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988359724&partnerID=8YFLogxK

U2 - 10.1111/cup.12751

DO - 10.1111/cup.12751

M3 - Article

C2 - 27247109

AN - SCOPUS:84988359724

VL - 43

SP - 830

EP - 837

JO - Journal of Cutaneous Pathology

JF - Journal of Cutaneous Pathology

SN - 0303-6987

IS - 10

ER -