Factors associated with use of immunohistochemical markers in the histopathological diagnosis of cutaneous melanocytic lesions.
Biomarkers
/ metabolism
Biopsy
/ methods
Female
Histological Techniques
/ methods
Humans
Immunohistochemistry
/ methods
Male
Melanocytes
/ pathology
Melanoma
/ diagnosis
Middle Aged
Observer Variation
Pathologists
/ statistics & numerical data
Pathology, Clinical
/ methods
Skin
/ pathology
Skin Neoplasms
/ metabolism
Surveys and Questionnaires
United States
histopathological diagnosis
immunohistochemical markers
melanoma
Journal
Journal of cutaneous pathology
ISSN: 1600-0560
Titre abrégé: J Cutan Pathol
Pays: United States
ID NLM: 0425124
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
28
08
2019
revised:
06
04
2020
accepted:
28
04
2020
pubmed:
10
5
2020
medline:
7
9
2021
entrez:
9
5
2020
Statut:
ppublish
Résumé
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. 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. 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). Substantial variability exists among pathologists in utilizing IHC.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
Substantial variability exists among pathologists in utilizing IHC.
Identifiants
pubmed: 32383301
doi: 10.1111/cup.13736
pmc: PMC8845493
mid: NIHMS1599280
doi:
Substances chimiques
Biomarkers
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
896-902Subventions
Organisme : NCI NIH HHS
ID : R01CA201376
Pays : United States
Organisme : NCI NIH HHS
ID : R01CA200690
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA201376
Pays : United States
Organisme : NICHD NIH HHS
ID : T32 HD007545
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA200690
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA151306
Pays : United States
Organisme : NCI NIH HHS
ID : R01CA151306
Pays : United States
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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