Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama.
Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama.
J Am Acad Dermatol. 2020 Jan;82(1):87-93. doi: 10.1016/j.jaad.2019.07.037. Epub 2019 Jul 19.
Biopsies of dysplastic nevi processed by bread-loafing allow for limited margin assessment; however, reported biopsy margins often influence management.
To evaluate the negative predictive value of biopsy margins of dysplastic nevi.
A retrospective search of a single academic institution's pathology database was conducted to identify all biopsy specimens of dysplastic nevi between January 1, 2015, and December 31, 2017. Biopsy specimen margin assessments were compared with excision pathology reports to calculate negative predictive value and to assess the frequency of residual nevus on excision after positive biopsy margins.
A total of 1245 dysplastic nevi from 934 patients were identified. Clear biopsy margins had a negative predictive value for the absence of residual nevus on excision of 87.3% for dysplastic nevi of moderate atypia or greater. Residual nevus was identified on excision in 29.41% of cases of dysplastic nevi of moderate atypia or greater when initial biopsy margins were positive.
This was a retrospective, single-institution study. The calculations likely overestimate the true negative predictive value of biopsy margins because of processing of excision specimens by bread-loafing.
This study provides additional evidence that reported biopsy margins are not representative of true margin status.
通过面包切块处理的发育不良痣活检可进行有限的边缘评估；然而，报告的活检边缘通常会影响管理。
评估发育不良痣活检边缘的阴性预测值。
对 2015 年 1 月 1 日至 2017 年 12 月 31 日期间，一家学术机构的病理学数据库进行了回顾性搜索，以确定所有发育不良痣的活检标本。将活检标本边缘评估与切除病理学报告进行比较，以计算阴性预测值，并评估阳性活检边缘后切除时残留痣的频率。
共确定了 934 例患者的 1245 个发育不良痣。对于中度异型性或更高级别的发育不良痣，清晰的活检边缘对于切除时无残留痣的阴性预测值为 87.3%。当初始活检边缘为阳性时，中度异型性或更高级别的发育不良痣中，有 29.41%的病例在切除时发现了残留痣。
这是一项回顾性、单机构研究。由于采用面包切块处理切除标本，这些计算可能高估了活检边缘的真实阴性预测值。
本研究进一步证明了报告的活检边缘不能代表真实的边缘状态。
