Florell Scott R, Smoller Bruce R, Boucher Kenneth M, Grossman Douglas, Harris Ronald M, Bowen Glen M, Leachman Sancy A
The Melanoma Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84132, USA.
J Am Acad Dermatol. 2008 Nov;59(5):814-21. doi: 10.1016/j.jaad.2008.07.020.
Research on melanocytic nevi predominantly utilizes formalin-fixed, paraffin-embedded tissue, largely limiting research to morphologic and immunohistochemical observations. Withholding portions of fresh nevus tissue for molecular studies could result in the loss of important diagnostic material.
This study prospectively evaluated melanocytic nevi for histologic homogeneity to determine if using a portion for research would have affected diagnosis.
Thirty-three subjects were enrolled in a prospective study in which pigmented lesions were chosen for biopsy on a clinical basis. Lesions were sectioned and each piece submitted in a separate block (mean, 2.7; range 2-5 blocks per lesion). Slides from nevi were examined in two phases. In phase I, sections of nevi were randomized and a diagnosis was rendered for each section of nevus. In phase II, the dermatopathologist reviewed all slides for each nevus as a case, similar to the original interpretation of the lesion provided to the clinician. Diagnoses from phases I and II were compared with the original diagnosis.
Case material included 51 melanocytic lesions from 31 subjects. The phase I diagnosis matched the original diagnosis for 99 of 121 slides that showed a melanocytic lesion (82%). The phase II diagnosis matched the original diagnosis for 45 of 51 specimens (88%).
The study was limited by: a small number of specimens; the clinician could have chosen clinically homogeneous nevi for biopsy; effect of interobserver and intraobserver variability on diagnosis.
For the majority of melanocytic nevi in this study, the diagnostic information present in one section of a melanocytic nevus could be extrapolated to the remainder of the specimen without adverse consequences from a diagnostic or therapeutic perspective.
黑素细胞痣的研究主要利用福尔马林固定、石蜡包埋的组织，这在很大程度上限制了研究仅能进行形态学和免疫组织化学观察。保留新鲜痣组织的部分用于分子研究可能会导致重要诊断材料的丢失。
本研究前瞻性评估黑素细胞痣的组织学同质性，以确定使用一部分组织进行研究是否会影响诊断。
33名受试者参与了一项前瞻性研究，其中色素性病变根据临床情况选择进行活检。病变被切片，每片分别包埋在一个单独的组织块中（平均每个病变2.7个组织块；范围为每个病变2 - 5个组织块）。痣的切片分两个阶段进行检查。在第一阶段，痣的切片被随机分组，对每个痣切片做出诊断。在第二阶段，皮肤病理学家将每个痣的所有切片作为一个病例进行复查，类似于向临床医生提供的病变原始解读。将第一阶段和第二阶段的诊断与原始诊断进行比较。
病例材料包括来自31名受试者的51个黑素细胞病变。在显示黑素细胞病变的121张切片中，第一阶段诊断与原始诊断相符的有99张（82%）。在51个标本中，第二阶段诊断与原始诊断相符的有45个（88%）。
本研究的局限性在于：标本数量少；临床医生可能选择了临床上同质的痣进行活检；观察者间和观察者内变异性对诊断的影响。
对于本研究中的大多数黑素细胞痣，从诊断或治疗角度来看，黑素细胞痣一个切片中的诊断信息可以外推到标本的其余部分，而不会产生不良后果。
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