Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA.
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Cutan Pathol. 2022 Feb;49(2):153-162. doi: 10.1111/cup.14126. Epub 2021 Sep 21.
Histopathologically ambiguous melanocytic lesions lead some pathologists to list multiple diagnostic considerations in the pathology report. The frequency and circumstance of multiple diagnostic considerations remain poorly characterized.
Two hundred and forty skin biopsy samples were interpreted by 187 pathologists (8976 independent diagnoses) and classified according to a diagnostic/treatment stratification (MPATH-Dx).
Multiple diagnoses in different MPATH-Dx classes were used in n = 1320 (14.7%) interpretations, with 97% of pathologists and 91% of cases having at least one such interpretation. Multiple diagnoses were more common for intermediate risk lesions and are associated with greater subjective difficulty and lower confidence. We estimate that 6% of pathology reports for melanocytic lesions in the United States contain two diagnoses of different MPATH-Dx prognostic classes, and 2% of cases are given two diagnoses with significant treatment implications.
Difficult melanocytic diagnoses in skin may necessitate multiple diagnostic considerations; however, as patients increasingly access their health records and retrieve pathology reports (as mandated by US law), uncertainty should be expressed unambiguously.
组织病理表现不明确的黑素细胞性病变可能导致部分病理医生在病理报告中列出多种诊断考虑因素。但目前对于这种多种诊断考虑因素的发生频率和情况仍知之甚少。
240 份皮肤活检样本由 187 名病理医生（8976 个独立诊断）进行解读，并根据诊断/治疗分层（MPATH-Dx）进行分类。
在 n=1320（14.7%）的解读中使用了不同 MPATH-Dx 类别的多个诊断，97%的病理医生和 91%的病例至少有一次这样的解读。中间风险病变更常见多种诊断，与更高的主观难度和更低的诊断信心相关。我们估计，美国黑素细胞性病变的病理报告中，有 6%包含两种不同 MPATH-Dx 预后类别的诊断，2%的病例有两种具有重要治疗意义的诊断。
皮肤中具有挑战性的黑素细胞性诊断可能需要多种诊断考虑；然而，随着美国法律要求患者越来越多地访问他们的健康记录并获取病理报告，不确定性应该明确表达。
