Pathologist Characteristics Associated with Accuracy and Reproducibility of Melanocytic Skin Lesion Interpretation

Publication date: Available online 7 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): David E. Elder, Mike Piepkorn, Raymond L. Barnhill, Gary M. Longton, Heidi D. Nelson, Stevan R. Knezevich, Margaret S. Pepe, Patricia A. Carney, Linda J. Titus, Tracy Onega, Anna N.A. Tosteson, Martin A. Weinstock, Joann G. Elmore
BackgroundDiagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear.ObjectiveIdentify pathologist characteristics associated with rates of accuracy and reproducibility.MethodsPathologists independently interpreted the same set of biopsies of melanocytic lesions on two occasions. Diagnoses were categorized into one of five classes according to the MPATH-Dx^© system. Reproducibility was determined by pathologists' concordance of diagnoses across two 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.ResultsRates of diagnostic reproducibility and accuracy were highest among pathologists with board certification and/or fellowship training in dermatopathology, and those with ≥5 years of experience. In addition, accuracy was high among pathologists with higher caseload composition and volume of melanocytic lesions.LimitationsData gathered in a test set situation using a classification tool not currently in clinical use.ConclusionDiagnoses 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 on patient outcomes of these referrals requires additional research.