Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky.
Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Cancer. 2021 Sep 1;127(17):3125-3136. doi: 10.1002/cncr.33612. Epub 2021 May 4.
Synoptic reporting is recommended by many guideline committees to encourage the thorough histologic documentation necessary for optimal management of patients with melanoma.
One hundred fifty-one pathologists from 40 US states interpreted 41 invasive melanoma cases. For each synoptic reporting factor, the authors identified cases with "complete agreement" (all participants recorded the same value) versus any disagreement. Pairwise agreement was calculated for each case as the proportion of pairs of responses that agreed, where paired responses were generated by the comparison of each reviewer's response with all others.
There was complete agreement among all reviewers for 22 of the 41 cases (54%) on Breslow thickness dichotomized at 0.8 mm, with pairwise agreement ranging from 49% to 100% across the 41 cases. There was complete agreement for "no ulceration" in 24 of the 41 cases (59%), with pairwise agreement ranging from 42% to 100%. Tumor transected at base had complete agreement for 26 of the 41 cases (63%), with pairwise agreement ranging from 31% to 100%. Mitotic rate, categorized as 0/mm , 1/mm , or 2/mm , had complete agreement for 17 of the 41 cases (41%), with pairwise agreement ranging from 36% to 100%. Regression saw complete agreement for 14 of 41 cases (34%), with pairwise agreement ranging from 40% to 100%. Lymphovascular invasion, perineural invasion, and microscopic satellites were rarely reported as present. Respectively, these prognostic factors had complete agreement for 32 (78%), 37 (90%), and 18 (44%) of the 41 cases, and the ranges of pairwise agreement were 47% to 100%, 70% to 100%, and 53% to 100%, respectively.
These findings alert pathologists and clinicians to the problem of interobserver variability in recording critical prognostic factors.
This study addresses variability in the assessment and reporting of critical characteristics of invasive melanomas that are used by clinicians to guide patient care. The authors characterize the diagnostic variability among pathologists and their reporting methods in light of recently updated national guidelines. Results demonstrate considerable variability in the diagnostic reporting of melanoma with regard to the following: Breslow thickness, mitotic rate, ulceration, regression, and microscopic satellites. This work serves to alert pathologists and clinicians to the existence of variability in reporting these prognostic factors.
许多指南委员会建议采用摘要报告，以鼓励对黑色素瘤患者进行彻底的组织学记录，从而实现最佳管理。
来自美国 40 个州的 151 名病理学家对 41 例侵袭性黑色素瘤病例进行了解读。对于每个摘要报告因素，作者确定了“完全一致”（所有参与者记录了相同的值）与任何不一致的病例。对于每个病例，通过比较每个审查员的回复与其他所有回复来计算每对回复的一致性比例，从而确定每个病例的一致性。
在 41 例病例中，有 22 例（54%）在 Breslow 厚度分为 0.8mm 时，所有审阅者之间完全一致，而在 41 例病例中，配对一致性从 49%到 100%不等。在 41 例病例中，有 24 例（59%）“无溃疡”完全一致，配对一致性从 42%到 100%不等。在 41 例病例中，有 26 例（63%）肿瘤基底横切完全一致，配对一致性从 31%到 100%不等。有丝分裂率分为 0/mm、1/mm 或 2/mm，有 17 例（41%）完全一致，配对一致性从 36%到 100%不等。14 例（34%）病例中出现了退行性变，完全一致，配对一致性从 40%到 100%不等。淋巴管浸润、神经周围浸润和微卫星很少被报告为存在。分别来说，这些预后因素在 41 例病例中有 32 例（78%）、37 例（90%）和 18 例（44%）完全一致，配对一致性的范围分别为 47%到 100%、70%到 100%和 53%到 100%。
这些发现提醒病理学家和临床医生注意记录黑色素瘤关键预后因素的观察者间变异性问题。
本研究探讨了在评估和报告用于指导患者护理的侵袭性黑色素瘤关键特征方面的观察者间变异性。作者根据最新的国家指南，描述了病理学家之间的诊断变异性及其报告方法。结果表明，在以下方面，黑色素瘤的诊断报告存在相当大的变异性：Breslow 厚度、有丝分裂率、溃疡、退行性变和微卫星。这项工作提醒病理学家和临床医生注意报告这些预后因素存在的变异性。
