Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
J Clin Pathol. 2019 Jul;72(7):482-486. doi: 10.1136/jclinpath-2019-205767. Epub 2019 May 14.
The National Institute for Health and Care Excellence advocated the development of specialist skin cancer multidisciplinary teams (SSMDTs) for the management of higher risk invasive skin cancers in the UK. The interobserver variability in the histopathological assessment of primary cutaneous malignant melanoma (PCMM) is well recognised.
We evaluated the discordance rates in the assessment of the histopathological criteria of PCMM based on the eighth American Joint Committee on Cancer (AJCC) melanoma staging system and subsequent change in prognosis and management following pathology review by an SSMDT.
353 cases of PCMM were referred to our SSMDT between April 2015 and May 2016. Cases in which there was a discrepancy in one or more histological parameters following expert review were collected retrospectively. Of 341 eligible cases, there were 94 (27.6%) in which there was an alteration in any parameter. There was interobserver agreement in final diagnosis in 96.8%, Breslow thickness in 86.8%, ulceration in 98.2%, microsatellites in 98.5%, tumour mitotic rate in 88.9%, histological subtype in 92.4%, growth phase in 98.5%, angiolymphatic invasion in 97.7%, perineural invasion in 98.8%, regression in 95.3% and tumour-infiltrating lymphocytes in 95.0%. A corresponding change in AJCC stage occurred in 23 cases (6.7%), with a resulting change in clinical management in 10 cases (2.9%).
Disagreements in the pathological assessment of PCMM can have significant clinical implications for a small number of patients. Our findings highlight the value of the SSMDT for high-quality care of patients with melanoma in the UK.
英国国家健康与保健卓越研究所提倡成立皮肤癌多学科专家团队，以管理英国更高风险的侵袭性皮肤癌。原发性皮肤恶性黑色素瘤（PCMM）的组织病理学评估存在观察者间的变异性，这一点已得到广泛认可。
我们评估了基于第八版美国癌症联合委员会（AJCC）黑色素瘤分期系统的 PCMM 组织病理学标准评估中的不一致率，以及多学科专家团队对病理进行审查后，对预后和治疗的改变。
2015 年 4 月至 2016 年 5 月，我们的多学科专家团队共评估了 353 例 PCMM 病例。回顾性收集了专家审查后在一个或多个组织学参数上存在差异的病例。在 341 例符合条件的病例中，有 94 例（27.6%）的任何参数发生改变。最终诊断的观察者间一致性为 96.8%，Breslow 厚度为 86.8%，溃疡为 98.2%，微卫星为 98.5%，肿瘤有丝分裂率为 88.9%，组织学亚型为 92.4%，生长阶段为 98.5%，血管淋巴管侵犯为 97.7%，神经周围侵犯为 98.8%，消退为 95.3%，肿瘤浸润淋巴细胞为 95.0%。23 例（6.7%）的 AJCC 分期发生相应改变，其中 10 例（2.9%）的临床管理发生改变。
PCMM 的病理评估存在差异可能对少数患者具有重要的临床意义。我们的发现强调了多学科专家团队在英国为黑色素瘤患者提供高质量护理的价值。
