- 作者：Michael W. Piepkorn ; Raymond L. Barnhill ; David E. Elder ; Stevan R. Knezevich ; Patricia A. Carney ; Lisa M. Reisch ; Joann G. Elmore
- 关键词：diagnosis ; diagnostic errors ; discordance ; dysplasia ; melanoma ; nevi ; observer variability
- 刊名：Journal of the American Academy of Dermatology
- 出版年：January, 2014
- 年：2014
- 卷：70
- 期：1
- 页码：131-141
- 全文大小：3326 K
Background
The histologic diagnosis of melanoma and nevi can be subject to discordance and errors, potentially leading to inappropriate treatment and harm. Diagnostic terminology is not standardized, creating confusion for providers and patients and challenges for investigators.Objective
We sought to describe the development of a pathology reporting form for more precise research on melanoma and a diagnostic-treatment mapping tool for improved patient care and consistency in treatment.
Methods
Three dermatopathologists independently reviewed melanocytic lesions randomly selected from a dermatopathology database. Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) reporting schema evolved from iterative case review and form revision.
Results
Differences in diagnostic thresholds, interpretation, and nomenclature contributed to development of the MPATH-Dx histology reporting form, which groups lesions by similarities in histogenesis and degrees of atypia. Because preliminary results indicate greater agreement regarding suggested treatments than for specific diagnoses, the diverse terminologies of the MPATH-Dx histology reporting form were stratified by commonalities of treatments in the MPATH-Dx diagnostic-treatment mapping scheme.
Limitations
Without transformative advances in diagnostic paradigms, the interpretation of melanocytic lesions frequently remains subjective.
Conclusions
The MPATH-Dx diagnostic-treatment mapping scheme could diminish confusion for those receiving reports by categorizing diverse nomenclature into a hierarchy stratified by suggested management interventions.