Institutt for klinisk medisin, Universitetet i Oslo, og, Seksjon for hudsykdommer, Oslo universitetssykehus.
Oslo senter for biostatistikk og epidemiologi, og, Avdeling for biostatistikk, Institutt for medisinske basalfag, Universitetet i Oslo.
Tidsskr Nor Laegeforen. 2022 Oct 24;142(15). doi: 10.4045/tidsskr.22.0204. Print 2022 Oct 25.
Histopathological assessment of melanoma and other melanocytic skin lesions can be difficult and can vary between pathologists.
Histopathological slides of 196 melanocytic skin lesions from 2009 and 2018-2019 were obtained from the archive of the Department of Pathology at Oslo University Hospital and classified into six diagnostic categories: 1) benign nevus, 2) irregular/dysplastic nevus, i.e. dysplastic nevus with moderate atypia, 3) nevus with severe atypia, i.e. dysplastic nevus with severe atypia, 4) melanoma in situ, 5) superficial spreading or lentiginous melanoma and 6) nodular melanoma. The slides were then examined independently and blindly by three experienced pathologists and categorised in the same way. Interobserver agreement was assessed with Cohen's kappa, and agreement with the original diagnosis was assessed by the proportion of assessments in the same diagnostic category.
The kappa values for the assessments from the three pathologists ranged from 0.45 to 0.50. The proportion of reassessments in agreement with the original diagnostic category was 85.7 % (95 % CI 75.7 to 92.1), 29.2 % (19.9 to 40.5), 27.8 % (20.9 to 36.0), 78.3 % (70.4 to 84.5), 81.2 % (73.7 to 86.9) and 93.3 % (82.1 to 97.7), respectively, i.e. highest for nodular melanoma. The proportion of reassessments in which the diagnosis was more serious or less serious than the original diagnosis was higher and lower, respectively, for slides from 2009 than for slides from 2018-2019.
The differences between the pathologists' assessments and deviations from the original diagnoses can be explained by poorly reproducible diagnostic criteria, diagnostic entities with overlapping morphology and increasing awareness of early signs of malignancy. Some evolution in diagnostic practice cannot be ruled out.
黑色素瘤和其他黑色素细胞皮肤病变的组织病理学评估可能具有挑战性，并且在病理学家之间存在差异。
从奥斯陆大学医院病理学系的档案中获得了 196 例黑色素细胞皮肤病变的组织病理学切片，这些切片来自 2009 年和 2018-2019 年，并将其分为六个诊断类别：1）良性痣，2）不规则/发育不良痣，即中度异型性发育不良痣，3）高度异型性痣，即高度异型性发育不良痣，4）原位黑色素瘤，5）浅表扩散性或痣样黑色素瘤，6）结节性黑色素瘤。然后由三位经验丰富的病理学家独立且盲法检查这些切片，并以相同的方式进行分类。通过 Cohen's kappa 评估观察者间的一致性，通过同一诊断类别中评估的比例评估与原始诊断的一致性。
三位病理学家的评估kappa 值范围为 0.45 至 0.50。与原始诊断类别一致的重新评估比例分别为 85.7%（95%CI 75.7%至92.1%）、29.2%（19.9%至40.5%）、27.8%（20.9%至36.0%）、78.3%（70.4%至84.5%）、81.2%（73.7%至86.9%）和 93.3%（82.1%至97.7%），即结节性黑色素瘤的比例最高。与 2009 年的切片相比，2018-2019 年的切片中，重新评估的诊断更为严重或不那么严重的比例分别更高和更低。
病理学家评估之间的差异和与原始诊断的偏差可以用诊断标准的重现性差、形态学重叠的诊断实体以及对恶性早期迹象的认识提高来解释。不能排除诊断实践的某些演变。
