Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group

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• 作者：Jason P. Lott ; MD ; MHS ; MSHP^a ; Joann G. Elmore ; MD ; MPH^b ; ^{jelmore@u.washington.edu" class="auth_mail" title="E-mail the corresponding author} ; Ge A. Zhao ; MD^c ; Stevan R. Knezevich ; MD ; PhD^d ; Paul D. Frederick ; MPH ; MBA^b ; Lisa M. Reisch ; PhD^b ; Emily Y. Chu ; MD ; PhD^e ; Martin G. Cook ; MD^g ; Lyn M. Duncan ; MD^h ; Rosalie Elenitsas ; MD^e ; Pedram Gerami ; MDⁱ ; Gilles Landman ; MD^j ; Lori Lowe ; MD^k ; Jane L. Messina ; MD^l ; Martin C. Mihm ; MD^m ; Joost J. van den Oord ; MD ; PhDⁿ ; Michael S. Rabkin ; MD ; PhD^o ; Birgitta Schmidt ; MD^p ; Christopher R. Shea ; MD^q ; Sook Jung Yun ; MD ; PhD^r ; George X. Xu ; MD ; PhD^f ; Michael W. Piepkorn ; MD ; PhD^c ; David E. Elder ; MBChB ; FRCPA^f ; Raymond L. Barnhill ; MD^s ; on behalf of the International Melanoma Pathology Study Group
• 关键词：classification ; diagnosis ; dysplastic nevus ; melanoma ; Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis ; nevus ; pathology ; variability ; variation
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：75
• 期：2
• 页码：356-363
• 全文大小：1427 K

文摘

Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care.

Objective

We sought to evaluate the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) scheme, a 5-category classification system for melanocytic lesions.

Methods

Participants (n = 16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when necessary, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Interrater agreement and correlation between MPATH-Dx categorization and treatment suggestions were evaluated.

Results

Most participants were board-certified dermatopathologists (n = 15), age 50 years or older (n = 12), male (n = 9), based in the United States (n = 11), and primary academic faculty (n = 14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement after MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 (95% confidence interval 0.68-0.71) and 0.72 (95% confidence interval 0.71-0.73), respectively, whereas correlation between MPATH-Dx categorization and treatment suggestions was 0.91.

Limitations

This was a small sample size of experienced pathologists in a testing situation.

Conclusion

Varying diagnostic nomenclature can be classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care.