Departments of Medicine and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
JAMA Dermatol. 2018 Oct 1;154(10):1159-1166. doi: 10.1001/jamadermatol.2018.2388.
Use of digital whole-slide imaging (WSI) for dermatopathology in general has been noted to be similar to traditional microscopy (TM); however, concern has been noted that WSI is inferior for interpretation of melanocytic lesions. Since approximately 1 of every 4 skin biopsies is of a melanocytic lesion, the use of WSI requires verification before use in clinical practice.
To compare pathologists' accuracy and reproducibility in diagnosing melanocytic lesions using Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) categories when analyzing by TM vs WSI.
DESIGN, SETTING, AND PARTICIPANTS: A total of 87 pathologists in community-based and academic settings from 10 US states were randomized with stratification based on clinical experience to interpret in TM format 180 skin biopsy cases of melanocytic lesions, including 90 invasive melanoma, divided into 5 sets of 36 cases (phase 1). The pathologists were then randomized via stratified permuted block randomization with block size 2 to interpret cases in either TM (n = 46) or WSI format (n = 41), with each pathologist interpreting the same 36 cases on 2 separate occasions (phase 2). Diagnoses were categorized as MPATH-Dx categories I through V, with I indicating the least severe and V the most severe.
Accuracy with respect to a consensus reference diagnosis and the reproducibility of repeated interpretations of the same cases.
Of the 87 pathologists in the study, 46% (40) were women and the mean (SD) age was 50.7 (10.2) years. Except for class III melanocytic lesions, the diagnostic categories showed no significant differences in diagnostic accuracy between TM and WSI interpretation. Discordance was lower among class III lesions for the TM interpretation arm (51%; 95% CI, 46%-57%) than for the WSI arm (61%; 95% CI, 53%-69%) (P = .05). This difference is likely to have clinical significance, because 6% of TM vs 11% of WSI class III lesions were interpreted as invasive melanoma. Reproducibility was similar between the traditional and digital formats overall (66.4%; 95% CI, 63.3%-69.3%; and 62.7%; 95% CI, 59.5%-65.7%, respectively), and for all classes, although class III showed a nonsignificant lower intraobserver agreement for digital. Significantly more mitotic figures were detected with TM compared with WSI: mean (SD) TM, 6.72 (2.89); WSI, 5.84 (2.56); P = .002.
Interpretive accuracy for melanocytic lesions was similar for WSI and TM slides except for class III lesions. We found no clinically meaningful differences in reproducibility for any of the diagnostic classes.
一般来说，数字全玻片成像（WSI）在皮肤科病理学中的应用与传统显微镜（TM）相似；然而，人们担心 WSI 在解释黑素细胞病变方面较差。由于大约每 4 个皮肤活检中就有 1 个是黑素细胞病变，因此在临床实践中使用 WSI 之前需要进行验证。
比较病理学家使用黑素细胞病理学评估工具和诊断层次结构（MPATH-Dx）类别在分析 TM 与 WSI 时诊断黑素细胞病变的准确性和可重复性。
设计、设置和参与者：共有来自美国 10 个州的 87 名在社区和学术环境中工作的病理学家，根据临床经验进行分层随机分配，以 TM 格式分析 180 例黑素细胞病变皮肤活检病例，包括 90 例侵袭性黑色素瘤，分为 5 组 36 例（第 1 阶段）。然后，病理学家通过分层随机化排列块随机化（块大小为 2），以 TM（n=46）或 WSI 格式（n=41）进行分析，每个病理学家在 2 次不同的情况下分析相同的 36 个病例（第 2 阶段）。诊断分为 MPATH-Dx 类别 I 至 V，I 表示最不严重，V 表示最严重。
参照共识参考诊断的准确性和相同病例重复解释的可重复性。
在这项研究的 87 名病理学家中，46%（40 名）为女性，平均（SD）年龄为 50.7（10.2）岁。除了 III 类黑素细胞病变外，TM 和 WSI 解释的诊断类别在诊断准确性方面没有显著差异。TM 解释臂的 III 类病变的不一致性较低（51%；95%CI，46%-57%），而 WSI 臂的不一致性较高（61%；95%CI，53%-69%）（P=0.05）。这一差异可能具有临床意义，因为 TM 的 6%的 III 类病变被解释为侵袭性黑色素瘤，而 WSI 的为 11%。总体而言，传统和数字格式的可重复性相似（分别为 66.4%；95%CI，63.3%-69.3%；62.7%；95%CI，59.5%-65.7%），所有类别也是如此，尽管 III 类的数字格式观察者间一致性略低，但无统计学意义。与 WSI 相比，TM 检测到的有丝分裂计数明显更多：平均（SD）TM，6.72（2.89）；WSI，5.84（2.56）；P=0.002。
WSI 和 TM 玻片的黑素细胞病变解释准确性相似，除了 III 类病变。我们没有发现任何诊断类别在可重复性方面有临床意义的差异。
