Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.
J Am Acad Dermatol. 2012 Sep;67(3):387-94. doi: 10.1016/j.jaad.2011.10.026. Epub 2011 Dec 9.
Diagnostic practice by dermatopathologists evaluating pigmented lesions may have evolved over time.
We sought to investigate diagnostic drift among a group of dermatopathologists asked to re-evaluate cases initially diagnosed 20 years ago.
Twenty nine cases of dysplastic nevi with severe atypia and 11 cases of thin radial growth-phase melanoma from 1988 through 1990 were retrieved from the pathology files of the Massachusetts General Hospital. All dermatopathologists who had rendered an original diagnosis for any of the 40 slides and the current faculty in the Massachusetts General Hospital Dermatopathology Unit were invited to evaluate the slide set in 2008 through 2009.
The mean number of melanoma diagnoses by the 9 study participants was 18, an increase from the original 11 melanoma diagnoses. A majority agreed with the original diagnosis of melanoma in all 11 cases. In contrast, a majority of current raters diagnosed melanoma in 4 of the 29 cases originally reported as dysplastic nevus with severe atypia. Interrater agreement over time was excellent (kappa 0.88) and fair (kappa 0.47) for cases originally diagnosed as melanoma and severely atypical dysplastic nevus, respectively.
The unbalanced composition of the slide set, lack of access to clinical or demographic information, access to only one diagnostic slide, and imposed dichotomous categorization of tumors were limitations.
A selected cohort of dermatopathologists demonstrated a general trend toward the reclassification of prior nonmalignant diagnoses of severely atypical dysplastic nevi as malignant but did not tend to revise prior diagnoses of cutaneous melanoma as benign.
皮肤科病理学家评估色素性病变的诊断实践可能随时间而演变。
我们旨在研究一组皮肤科病理学家的诊断漂移情况，这些病理学家被要求重新评估 20 年前首次诊断的病例。
从马萨诸塞州综合医院的病理档案中检索了 1988 年至 1990 年间 29 例具有严重异型性的发育不良痣和 11 例薄的放射状生长期黑素瘤病例。邀请了所有对 40 张幻灯片中的任何一张进行过原始诊断的皮肤科病理学家以及马萨诸塞州综合医院皮肤科病理科的现任教员，于 2008 年至 2009 年对这一组幻灯片进行评估。
9 名研究参与者的平均黑色素瘤诊断数为 18 例，高于原始的 11 例黑色素瘤诊断数。大多数人对所有 11 例均同意最初的黑色素瘤诊断。相比之下，在最初报告为具有严重异型性的发育不良痣的 29 例病例中，大多数当前的评估者诊断为黑色素瘤的有 4 例。随着时间的推移，最初诊断为黑色素瘤和具有严重异型性的发育不良痣的病例的组间一致性很高（kappa 值分别为 0.88 和 0.47）。
幻灯片集的不平衡组成、缺乏获取临床或人口统计学信息的途径、仅获取一个诊断幻灯片以及对肿瘤进行强制性二分法分类是限制因素。
一组选定的皮肤科病理学家表现出将先前非恶性的严重异型性发育不良痣重新分类为恶性的普遍趋势，但他们并没有倾向于将先前的皮肤黑色素瘤诊断更改为良性。
