Melanoma Institute Australia, North Sydney, NSW, Australia.
Ann Surg Oncol. 2013 Nov;20(12):3969-75. doi: 10.1245/s10434-013-3092-5. Epub 2013 Jul 13.
Pathology reports are of critical importance for conveying information to clinicians who must make important management decisions for their patients. This study sought to assess and compare the precision, reproducibility, and completeness of external pathology reports and pathology reports generated by central review of each case in a large cohort of primary cutaneous melanoma patients.
Details of matched external pathology reports and corresponding review reports for 4,924 primary cutaneous invasive melanomas diagnosed and treated at Melanoma Institute Australia (MIA) between 2001 and 2011 were analyzed.
Interobserver agreement was excellent for American Joint Committee on Cancer (AJCC) T staging parameters: Breslow thickness (intraclass correlation coefficient [ICC] 0.984), mitotic rate (ICC 0.833), and ulceration (kappa statistic [κ] 0.823). All three of these important pathologic variables were included in 92.4 and 66.9% of review (MIA) and external (non-MIA) pathology reports, respectively. Completeness of MIA and non-MIA pathology reports for the three essential T-staging criteria increased significantly from 87.9 to 94.6% (χ(2) = 9.1, df = 1, P = 0.003) and from 53.2 to 74.3% (χ(2) = 35.0, df = 1, P < 0.001) over the 10-year study period. The AJCC N staging parameter of microsatellites was recorded in only 43% of non-MIA reports and demonstrated moderate concordance (κ = 0.560).
Reproducibility and completeness of pathology reports for many important histopathologic features have improved in recent years. Nevertheless, the documentation of microsatellites remained poor in external pathology reports. To enhance the usefulness of the pathology report for the provision of optimal melanoma patient care, continued efforts to encourage pathologists to document its key features appear warranted.
病理报告对于向临床医生传达信息至关重要，临床医生必须为患者做出重要的治疗决策。本研究旨在评估和比较大型原发性皮肤黑素瘤患者队列中外来病理报告和中心审查后生成的病理报告在准确性、可重复性和完整性方面的差异。
分析了 2001 年至 2011 年期间在澳大利亚黑素瘤研究所（MIA）诊断和治疗的 4924 例原发性皮肤浸润性黑素瘤的配对外部病理报告和相应的审查报告。
美国癌症联合委员会（AJCC）T 分期参数的观察者间一致性极好：Breslow 厚度（组内相关系数 [ICC] 0.984）、有丝分裂率（ICC 0.833）和溃疡（kappa 统计量 [κ] 0.823）。这三个重要的病理变量均包含在 92.4%和 66.9%的审查（MIA）和外部（非-MIA）病理报告中。MIA 和非-MIA 病理报告中，三个重要的 T 分期标准的完整性从 87.9%显著提高至 94.6%（χ²=9.1，df=1，P=0.003），从 53.2%显著提高至 74.3%（χ²=35.0，df=1，P<0.001）。AJCC N 分期参数微卫星仅记录在 43%的非-MIA 报告中，且一致性中等（κ=0.560）。
近年来，许多重要组织病理学特征的病理报告的可重复性和完整性得到了提高。然而，外部病理报告中微卫星的记录仍较差。为了提高病理报告在为患者提供最佳黑素瘤治疗方面的实用性，似乎有必要继续努力鼓励病理学家记录其关键特征。
