Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA.
Department of Dermatology, Brigham and Women's Hospital & Harvard Medical School, 221 Longwood Avenue, Boston, MB, 02215, USA.
Support Care Cancer. 2022 Oct;30(10):7827-7831. doi: 10.1007/s00520-022-07233-w. Epub 2022 Jul 9.
Supportive oncodermatology has been shown to improve several aspects of care for patients with cancer, but research showing improved diagnostic accuracy as a benefit of supportive oncodermatology is largely lacking. We thus aimed to evaluate different dermatologist groups' diagnostic accuracy for heterogenous cutaneous toxicities, using cutaneous immune-related adverse events (cirAEs) from immune checkpoint inhibitors (ICIs) as a test model.
Billing/requisition codes were used to identify patients who initiated programmed death-1/ligand-1 (PD-1/PD-L1) ICIs between 2010 and 2019 at Dana-Farber Cancer Institute/Brigham and Women's Hospital/Massachusetts General Hospital and underwent a subsequent skin biopsy. For each biopsied cirAE, pre-biopsy clinical diagnoses and post-biopsy clinico-pathologic diagnoses were retrospectively obtained from the medical record. Each biopsy-ordering dermatology provider was categorized as a general dermatologist or supportive oncodermatologist on the basis of providing clinical care within a cancer-center or attending on a hospital/clinic service dedicated to anti-cancer drug-related skin toxicities.
Of 4,183 patients who initiated anti-PD-1/PD-L1 therapy between 2010 and 2019, 101 (2.4%) patients collectively had 104 biopsied cirAEs. In more than one-third of all reviewed biopsied cirAEs (n = 39, 37.5%), histopathology results frequently led to revision of the pre-biopsy clinical diagnosis. The rate of initial cirAE misclassification amongst supportive oncodermatologists was significantly lower than that amongst general dermatologists (18/66, 27.3% vs. 21/38, 55.3%; Fischer's-exact-test p = 0.006).
Experienced supportive oncodermatologists may benefit patient care through increased diagnostic accuracy for skin toxicities from ICIs. Collectively, these results underscore that both skin biopsy from any dermatology provider and oncodermatology referral (where available) are valuable resources that should be integrated into supportive cancer care.
支持性肿瘤皮肤病学已被证明可以改善癌症患者护理的多个方面，但作为支持性肿瘤皮肤病学的益处，研究表明其可提高诊断准确性的证据却很少。因此，我们旨在评估不同皮肤科医生小组对异质性皮肤毒性的诊断准确性，以免疫检查点抑制剂（ICI）引起的皮肤免疫相关不良反应（cirAE）作为测试模型。
使用计费/申请代码来识别 2010 年至 2019 年期间在丹娜-法伯癌症研究所/布莱根妇女医院/麻省总医院开始接受程序性死亡受体 1/配体 1（PD-1/PD-L1）ICI 治疗的患者，并随后进行皮肤活检。对于每例活检的 cirAE，从病历中回顾性获得活检前的临床诊断和活检后的临床病理诊断。根据在癌症中心提供临床护理或在专门从事抗癌药物相关皮肤毒性的医院/诊所服务中就诊，将每位活检医嘱的皮肤科医生分为普通皮肤科医生或支持性肿瘤皮肤科医生。
在 2010 年至 2019 年期间接受抗 PD-1/PD-L1 治疗的 4183 名患者中，共有 101 名（2.4%）患者共发生 104 例活检 cirAE。在所有回顾的活检 cirAE 中，超过三分之一（n=39，37.5%）的病例中，组织病理学结果经常导致活检前临床诊断的修订。与普通皮肤科医生相比，支持性肿瘤皮肤科医生的初始 cirAE 误诊率明显更低（18/66，27.3%比 21/38，55.3%；Fischer 精确检验，p=0.006）。
经验丰富的支持性肿瘤皮肤科医生可能通过提高对 ICI 引起的皮肤毒性的诊断准确性来改善患者的护理。总的来说，这些结果强调了皮肤科医生的皮肤活检和肿瘤皮肤科医生的转诊（如有）都是有价值的资源，应整合到支持性癌症护理中。
