Jacobsen Emilie, Hippe Daniel S, Lachance Kristina, Perrone Marie E, Chang Oliver H, Shinohara Michi M
School of Medicine, University of Washington, Seattle, WA.
Department of Radiology, University of Washington, Seattle, WA.
Am J Dermatopathol. 2020 Mar;42(3):186-190. doi: 10.1097/DAD.0000000000001553.
Significant communication occurs between pathologists and clinicians through the dermatopathology report. Our objective was to describe clinician preference about reporting of the margin status of skin biopsies of nonmelanoma skin cancers. An anonymous survey was sent to 243 medical providers who submitted specimens to a single institution university medical center; 50 complete responses from attending-level providers and advance practice providers were received. The majority (96%) of those surveyed indicated margins should be reported on skin biopsies of neoplasms, particularly nonmelanoma skin cancers (basal cell carcinoma 96% and squamous cell carcinoma 92%) and atypical nevi (96%). When asked about particular language used to describe the margin status, some phrasing led to more variance in respondents' clinical management decisions, with 96%-98% of respondents making the same decision when presented with "unambiguous" terms and 58%-84% of respondents making the same decision when presented with "ambiguous" language (P < 0.001). Respondents generally preferred "unambiguous" margin descriptions when shown an involved margin (70% vs. 30%, P < 0.001) but accepted "ambiguous" language when the margin was clearly uninvolved (68% vs. 32%, P = 0.015). Most respondents (88%) desire inclusion of treatment recommendations in dermatopathology reports. Microscopic descriptions were highly utilized, particularly by nondermatology trained clinicians (97% vs. 80%, P = 0.09). Clinicians desire inclusion of margins for skin biopsies in dermatopathology reports, at least in some circumstances. The choice of language used to describe the margin status in dermatopathology reports has important implications for patient care. Margin descriptors that are unclear or ambiguous may lead to more variance in clinical management.
病理学家和临床医生通过皮肤病理学报告进行重要的沟通。我们的目的是描述临床医生对非黑色素瘤皮肤癌皮肤活检切缘状态报告的偏好。我们向243名向一所大学医学中心提交标本的医疗服务提供者发送了一份匿名调查问卷；收到了50名主治级提供者和高级执业提供者的完整回复。大多数（96%）受访者表示，肿瘤的皮肤活检，特别是非黑色素瘤皮肤癌（基底细胞癌96%，鳞状细胞癌92%）和非典型痣（96%）的切缘应该报告。当被问及用于描述切缘状态的具体措辞时，一些措辞在受访者的临床管理决策中导致了更多差异，当使用“明确”措辞时，96%-98%的受访者做出相同决策，而当使用“模糊”措辞时，58%-84%的受访者做出相同决策（P<0.001）。当显示切缘受累时，受访者通常更喜欢“明确”的切缘描述（70%对30%，P<0.001），但当切缘明显未受累时，他们接受“模糊”措辞（68%对32%，P=0.015）。大多数受访者（88%）希望在皮肤病理学报告中纳入治疗建议。微观描述的使用率很高，尤其是未接受皮肤科培训的临床医生（97%对80%，P=0.09）。临床医生希望在皮肤病理学报告中纳入皮肤活检的切缘情况，至少在某些情况下如此。皮肤病理学报告中用于描述切缘状态的语言选择对患者护理具有重要意义。不清楚或模糊的切缘描述可能会导致临床管理出现更多差异。
