Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation

David E. Elder, Michael W. Piepkorn, Raymond L. Barnhill, Gary M. Longton, Heidi Nelson, Stevan R. Knezevich, Margaret S. Pepe, Patricia (Patty) Carney, Linda J. Titus, Tracy Onega, Anna N.A. Tosteson, Martin A. Weinstock, Joann G. Elmore

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear. Objective: Identify pathologist characteristics associated with rates of accuracy and reproducibility. Methods: Pathologists independently interpreted the same set of biopsy specimens from melanocytic lesions on 2 occasions. Diagnoses were categorized into 1 of 5 classes according to the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis system. Reproducibility was determined by pathologists’ concordance of diagnoses across 2 occasions. Accuracy was defined by concordance with a consensus reference standard. Associations of pathologist characteristics with reproducibility and accuracy were assessed individually and in multivariable logistic regression models. Results: Rates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology and in those with 5 or more years of experience. In addition, accuracy was high among pathologists with a higher proportion of melanocytic lesions in their caseload composition and higher volume of melanocytic lesions. Limitations: Data gathered in a test set situation by using a classification tool not currently in clinical use. Conclusion: Diagnoses are more accurate among pathologists with specialty training and those with more experience interpreting melanocytic lesions. These findings support the practice of referring difficult cases to more experienced pathologists to improve diagnostic accuracy, although the impact of these referrals on patient outcomes requires additional research.

Original languageEnglish (US)
JournalJournal of the American Academy of Dermatology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Skin
Logistic Models
Pathologists
Certification
Referral and Consultation
Pathology
Biopsy
Research

Keywords

  • dermatopathology
  • diagnosis
  • discordance
  • melanocytic lesions
  • melanoma
  • observer variability
  • pathologist characteristics

ASJC Scopus subject areas

  • Dermatology

Cite this

Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation. / Elder, David E.; Piepkorn, Michael W.; Barnhill, Raymond L.; Longton, Gary M.; Nelson, Heidi; Knezevich, Stevan R.; Pepe, Margaret S.; Carney, Patricia (Patty); Titus, Linda J.; Onega, Tracy; Tosteson, Anna N.A.; Weinstock, Martin A.; Elmore, Joann G.

In: Journal of the American Academy of Dermatology, 01.01.2018.

Research output: Contribution to journalArticle

Elder, DE, Piepkorn, MW, Barnhill, RL, Longton, GM, Nelson, H, Knezevich, SR, Pepe, MS, Carney, PP, Titus, LJ, Onega, T, Tosteson, ANA, Weinstock, MA & Elmore, JG 2018, 'Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation', Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2018.02.070
Elder, David E. ; Piepkorn, Michael W. ; Barnhill, Raymond L. ; Longton, Gary M. ; Nelson, Heidi ; Knezevich, Stevan R. ; Pepe, Margaret S. ; Carney, Patricia (Patty) ; Titus, Linda J. ; Onega, Tracy ; Tosteson, Anna N.A. ; Weinstock, Martin A. ; Elmore, Joann G. / Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation. In: Journal of the American Academy of Dermatology. 2018.
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abstract = "Background: Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear. Objective: Identify pathologist characteristics associated with rates of accuracy and reproducibility. Methods: Pathologists independently interpreted the same set of biopsy specimens from melanocytic lesions on 2 occasions. Diagnoses were categorized into 1 of 5 classes according to the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis system. Reproducibility was determined by pathologists’ concordance of diagnoses across 2 occasions. Accuracy was defined by concordance with a consensus reference standard. Associations of pathologist characteristics with reproducibility and accuracy were assessed individually and in multivariable logistic regression models. Results: Rates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology and in those with 5 or more years of experience. In addition, accuracy was high among pathologists with a higher proportion of melanocytic lesions in their caseload composition and higher volume of melanocytic lesions. Limitations: Data gathered in a test set situation by using a classification tool not currently in clinical use. Conclusion: Diagnoses are more accurate among pathologists with specialty training and those with more experience interpreting melanocytic lesions. These findings support the practice of referring difficult cases to more experienced pathologists to improve diagnostic accuracy, although the impact of these referrals on patient outcomes requires additional research.",
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AB - Background: Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear. Objective: Identify pathologist characteristics associated with rates of accuracy and reproducibility. Methods: Pathologists independently interpreted the same set of biopsy specimens from melanocytic lesions on 2 occasions. Diagnoses were categorized into 1 of 5 classes according to the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis system. Reproducibility was determined by pathologists’ concordance of diagnoses across 2 occasions. Accuracy was defined by concordance with a consensus reference standard. Associations of pathologist characteristics with reproducibility and accuracy were assessed individually and in multivariable logistic regression models. Results: Rates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology and in those with 5 or more years of experience. In addition, accuracy was high among pathologists with a higher proportion of melanocytic lesions in their caseload composition and higher volume of melanocytic lesions. Limitations: Data gathered in a test set situation by using a classification tool not currently in clinical use. Conclusion: Diagnoses are more accurate among pathologists with specialty training and those with more experience interpreting melanocytic lesions. These findings support the practice of referring difficult cases to more experienced pathologists to improve diagnostic accuracy, although the impact of these referrals on patient outcomes requires additional research.

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