Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, USA.
Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California, USA.
J Cutan Pathol. 2022 Mar;49(3):231-245. doi: 10.1111/cup.14135. Epub 2021 Oct 19.
Appropriate use criteria (AUC) provide patient-centered physician guidance in test selection. An initial set of AUC was reported by the American Society of Dermatopathology (ASDP) in 2018. AUC reflect evidence collected at single timepoints and may be affected by evolving evidence and experience. The objective of this study was to update and expand AUC for selected tests.
RAND/UCLA (RAND Corporation [Santa Monica, CA]/University of California Los Angeles) methodology used includes the following: (a) literature review; (b) review of previously rated tests and previously employed clinical scenarios; (c) selection of previously rated tests for new ratings; (d) development of new clinical scenarios; (e) selection of additional tests; (f) three rating rounds with feedback and group discussion after rounds 1 and 2.
For 220 clinical scenarios comprising lymphoproliferative (light chain clonality), melanocytic (comparative genomic hybridization, fluorescence in situ hybridization, reverse transcription polymerase chain reaction, telomerase reverse transcriptase promoter), vascular disorders (MYC), and inflammatory dermatoses (periodic acid-Schiff, Gömöri methenamine silver), consensus by panel raters was reached in 172 of 220 (78%) scenarios, with 103 of 148 (70%) rated "usually appropriate" or "rarely appropriate" and 45 of 148 (30%), "appropriateness uncertain."
The study design only measures appropriateness. Cost, availability, test comparison, and additional clinical considerations are not measured. The possibility that the findings of this study may be influenced by the inherent biases of the dermatopathologists involved in the study cannot be excluded.
AUC are reported for selected diagnostic tests in clinical scenarios that occur in dermatopathology practice. Adhering to AUC may reduce inappropriate test utilization and improve healthcare delivery.
适宜性使用标准 (AUC) 为医生在选择检测时提供以患者为中心的指导。美国皮肤病理学会 (ASDP) 于 2018 年首次报告了一组 AUC。AUC 反映了在单一时间点收集的证据，并且可能受到不断发展的证据和经验的影响。本研究的目的是更新和扩展选定测试的 AUC。
RAND/UCLA（兰德公司[加利福尼亚州圣莫尼卡]/加利福尼亚大学洛杉矶分校]）使用的方法包括：(a) 文献综述；(b) 审查先前评分的测试和先前采用的临床情况；(c) 为新评分选择先前评分的测试；(d) 开发新的临床情况；(e) 选择额外的测试；(f) 三轮评分，在第 1 轮和第 2 轮后进行反馈和小组讨论。
对于包含淋巴增生（轻链克隆性）、黑素细胞（比较基因组杂交、荧光原位杂交、逆转录聚合酶链反应、端粒酶逆转录酶启动子）、血管疾病（MYC）和炎症性皮肤病（过碘酸-希夫、Gömöri 美蓝）的 220 个临床情况，小组评分员在 220 个（78%）情况下达成共识，其中 148 个中的 103 个（70%）被评为“通常适宜”或“很少适宜”，而 148 个中的 45 个（30%）被评为“适宜性不确定”。
该研究设计仅衡量适宜性。未测量成本、可用性、测试比较和其他临床考虑因素。不能排除参与研究的皮肤病理学家的固有偏见可能影响本研究结果的可能性。
报告了在皮肤科病理实践中发生的临床情况下选定诊断测试的 AUC。遵循 AUC 可能会减少不适当的测试利用并改善医疗保健服务。
