Chia Justin C, Abi Daoud Marie S, Williamson Tyler S, Kurwa Habib A
1 Division of Dermatology, University of Calgary, Calgary, AB, Canada.
2 Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
J Cutan Med Surg. 2019 Jan/Feb;23(1):20-28. doi: 10.1177/1203475418782146. Epub 2018 Jun 11.
: Mohs micrographic surgery (MMS) is a surgical modality that achieves high cure rates of nonmelanoma skin cancers but is dependent on accurate histologic examination of surgical margins. Therefore, quality assurance is essential to ongoing assessment of histological margins.
: To prospectively determine the concordance rate between a Mohs surgeon (MS) and dermatopathologist (DP) with respect to tumour status (ie, present or absent) and tumour type. Secondary end points were to determine the relationship between discordant interpretations and slide quality and to assess the feasibility of using an electronic webform for data collection.
: Ten percent (10%) of the planned MMS cases between January 2015 and March 2016 were randomly selected by a histotechnologist at the start of each month. The MS and DP were blinded to the chosen cases, and slides were reviewed independently at the beginning of the following month. Data were collected using an online webform. A blinded third party determined if there were discrepancies in interpretation, and any discordant slides were reviewed together and a consensus was reached.
: A total of 270 slides from 54 total cases were reviewed. The overall tumour status concordance rate was 93.6%. Cohen's κ was 0.86. Tumour type concordance was 98.9%. No discrepancy required a change in patient care. All discrepant slides were from cases that required multiple stages.
: This is the first study looking at MS-DP concordance in Canada, and our findings support the MS acting as his or her own pathologist.
莫氏显微描记手术（MMS）是一种手术方式，能实现非黑色素瘤皮肤癌的高治愈率，但依赖于手术切缘的准确组织学检查。因此，质量保证对于持续评估组织学切缘至关重要。
前瞻性确定莫氏外科医生（MS）与皮肤病理学家（DP）在肿瘤状态（即存在或不存在）和肿瘤类型方面的一致性率。次要终点是确定不一致解读与玻片质量之间的关系，并评估使用电子网络表单进行数据收集的可行性。
2015年1月至2016年3月计划进行的MMS病例的10%由组织技术人员在每月初随机选择。MS和DP对所选病例不知情，在下个月初独立审查玻片。使用在线网络表单收集数据。由一位不知情的第三方确定解读是否存在差异，任何不一致的玻片一起审查并达成共识。
共审查了来自54例病例的270张玻片。总体肿瘤状态一致性率为93.6%。科恩κ系数为0.86。肿瘤类型一致性为98.9%。没有差异需要改变患者护理。所有不一致的玻片均来自需要多个阶段的病例。
这是加拿大第一项研究MS - DP一致性的研究，我们的研究结果支持MS担任自己的病理学家。
