Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2021 Mar;223:60-74. doi: 10.1016/j.ajo.2020.10.020. Epub 2020 Oct 30.
We sought to compare the sensitivity, specificity, accuracy, and interobserver agreement of the two most commonly used classification systems for conjunctival melanocytic intraepithelial lesions with the new World Health Organization (WHO) classification.
Retrospective case series and evaluation of classification systems.
We reviewed the pathology and medical records of all patients who underwent a primary biopsy procedure for conjunctival primary acquired melanosis (PAM) at Wills Eye Hospital between 1974 and 2002 who had ≥36 months of follow-up. Data collected included age, sex, clinical findings, recurrence, and progression to melanoma. Twelve ophthalmic pathologists analyzed scanned hematoxylin and eosin-stained virtual microscopic slides using 3 classification systems: PAM, conjunctival melanocytic intraepithelial neoplasia, and the WHO 4th edition classification of conjunctival melanocytic intraepithelial lesions. Observer agreement, sensitivity, specificity, and diagnostic accuracy of each classification system were assessed.
There were 64 patients who underwent 83 primary excisions with cryotherapy for conjunctival PAM who had adequate tissue for histopathologic evaluation. The interobserver agreement in distinction between the low- and high-grade lesions was 76% for PAM, 67% for conjunctival melanocytic intraepithelial neoplasia, and 81% for WHO classification system. Low-grade lesions provided the greatest interpretative challenge with all 3 classification systems. The 3 classification systems had comparable accuracy of 81%-83% in their ability to identify lesions with potential for recurrence.
This study highlights the comparable strengths and limitations of the 3 classification systems for conjunctival melanocytic intraepithelial lesions and suggests that the simplified WHO classification scheme is appropriate for evaluation of these lesions.
我们旨在比较两种最常用于结膜黑色素上皮内病变的分类系统与新的世界卫生组织（WHO）分类法的敏感性、特异性、准确性和观察者间一致性。
回顾性病例系列和分类系统评估。
我们回顾了 1974 年至 2002 年间在威尔斯眼科医院接受结膜原发性获得性黑色素沉着症（PAM）初次活检的所有患者的病理学和病历，这些患者有≥36 个月的随访。收集的数据包括年龄、性别、临床发现、复发和进展为黑色素瘤。12 位眼科病理学家使用 3 种分类系统分析了扫描的苏木精和伊红染色虚拟显微镜载玻片：PAM、结膜黑色素上皮内瘤和 WHO 第 4 版结膜黑色素上皮内病变分类。评估了每种分类系统的观察者间一致性、敏感性、特异性和诊断准确性。
共有 64 名患者接受了 83 例冷冻治疗原发性结膜 PAM 切除术，这些患者有足够的组织进行组织病理学评估。在区分低级别和高级别病变方面，PAM 的观察者间一致性为 76%，结膜黑色素上皮内瘤为 67%，WHO 分类系统为 81%。所有 3 种分类系统中，低级别病变的解释最具挑战性。在识别具有复发潜力的病变方面，这 3 种分类系统的准确性相当，均为 81%-83%。
本研究强调了结膜黑色素上皮内病变的 3 种分类系统的可比性和局限性，并表明简化的 WHO 分类方案适用于这些病变的评估。
