Torre Kristin, Jhorar Preeti, Wu Rong, Pfeifer John, Elaba Zendee, Murphy Michael
University of Connecticut School of Medicine, Farmington, Connecticut.
Department of Dermatology, UConn Health, Farmington, Connecticut.
J Cutan Pathol. 2018 Jun;45(6):387-394. doi: 10.1111/cup.13126. Epub 2018 Mar 22.
We evaluated how dermatopathologists are employing molecular testing in the setting of neoplastic skin diseases, and assessed their opinions of the broader role and utility of molecular technologies in clinical practice.
A 15-question online survey was sent to Fellows of the American Society of Dermatopathology in April 2017.
One hundred and thirty-six dermatopathologists completed the survey (response rate = 16%). A majority (94%) of respondents reported experience with one or more molecular testing strategies. Sixty-two percent of dermatopathologists order 12 or more molecular tests per year, while 5% of respondents order 2 or fewer assays per year. More frequent utilization of molecular testing is associated with relevant instruction during residency training (P = .009), primary board certification in pathology (P = .008), academic medical center affiliation (P = <.0001), higher volume clinical practice (P = .0004), presence of on-site clinical molecular pathology/cytogenetics laboratory (P = .007), and greater physician confidence incorporating test results into histopathological assessments (P = <.0001).
Wider adoption of molecular testing in dermatopathology may be limited by factors such as physician training, test costs/insurance coverage, logistical issues and lack of evidence-based clinical practice guidelines. Dermatopathologists have concerns regarding clinical validity/utility and inappropriate/overuse of some molecular tests. The importance of longitudinal education in molecular technologies and their applications for trainee and practicing physicians is highlighted.
我们评估了皮肤病理学家在肿瘤性皮肤病的诊断中如何应用分子检测，并评估了他们对分子技术在临床实践中的更广泛作用和实用性的看法。
2017年4月，我们向美国皮肤病理学会会员发送了一份包含15个问题的在线调查问卷。
136名皮肤病理学家完成了调查（回复率 = 16%）。大多数（94%）受访者表示有使用一种或多种分子检测策略的经验。62%的皮肤病理学家每年进行12次或更多的分子检测，而5%的受访者每年进行2次或更少的检测。分子检测的更频繁使用与住院医师培训期间的相关指导（P = 0.009）、病理学初级委员会认证（P = 0.008）、学术医疗中心附属关系（P = <0.0001）、更高的临床实践量（P = 0.0004）、现场临床分子病理学/细胞遗传学实验室的存在（P = 0.007）以及医生将检测结果纳入组织病理学评估的更大信心（P = <0.0001）相关。
皮肤病理学中分子检测的更广泛应用可能受到诸如医生培训、检测成本/保险覆盖范围、后勤问题以及缺乏循证临床实践指南等因素的限制。皮肤病理学家对某些分子检测的临床有效性/实用性以及不适当/过度使用表示担忧。强调了对实习医生和执业医生进行分子技术及其应用的纵向教育的重要性。
