Piepkorn M W, Barnhill R L, Cannon-Albright L A, Elder D E, Goldgar D E, Lewis C M, Maize J C, Meyer L J, Rabkin M S, Sagebiel R W
Department of Internal Medicine (Dermatology), University of Utah School of Medicine, Salt Lake City.
J Am Acad Dermatol. 1994 May;30(5 Pt 1):707-14. doi: 10.1016/s0190-9622(08)81499-5.
Nevi that are clinically atypical and histologically dysplastic have been associated with increased melanoma risk. There are few reproducibility studies or population-based studies of nevus histology.
Our purpose was to quantify concordance in histologic diagnosis of melanocytic lesions among a diverse group of pathologists, to assess intraobserver concordance by comparing readings of the same slide as well as of adjacent recuts from the same block, to correlate histology with nevus appearance and melanoma risk, and to estimate the range of prevalence of histologic dysplasia.
Histologic slides were prepared from 149 tissue blocks of pigmented lesions from melanoma cases, relatives, and controls. Six dermatopathologists independently evaluated the lesions for histologic dysplasia, without prior agreement on criteria.
According to kappa statistics, intraobserver reproducibility was substantial, and interobserver concordance was fair, despite differences in criteria. The estimated prevalences of histologic dysplasia for the six pathologists ranged from 7% to 32%. Histologic dysplasia was correlated with nevus size for most observers, confounding the observed correlation between nevus appearance and histology.
Although experienced dermatopathologists use different diagnostic criteria for histologic dysplasia, their usage is consistent. Histologic changes ascribed to melanocytic dysplasia are prevalent in the white population for all pathologists. The term nevus with histologic dysplasia should be used in preference to dysplastic nevus.
临床上不典型且组织学上发育异常的痣与黑色素瘤风险增加有关。关于痣组织学的重复性研究或基于人群的研究很少。
我们的目的是量化不同病理学家群体对黑素细胞病变组织学诊断的一致性，通过比较同一张玻片以及同一组织块相邻切片的读数来评估观察者内一致性，将组织学与痣的外观和黑色素瘤风险相关联，并估计组织学发育异常的患病率范围。
从黑色素瘤病例、亲属和对照的149个色素沉着病变组织块制备组织学玻片。六位皮肤病理学家独立评估病变的组织学发育异常，事先未就标准达成一致。
根据kappa统计，尽管标准存在差异，但观察者内再现性良好，观察者间一致性尚可。六位病理学家对组织学发育异常的估计患病率在7%至32%之间。对于大多数观察者来说，组织学发育异常与痣的大小相关，这混淆了观察到的痣外观与组织学之间的相关性。
尽管经验丰富的皮肤病理学家对组织学发育异常使用不同的诊断标准，但他们的使用是一致的。对于所有病理学家来说，归因于黑素细胞发育异常的组织学变化在白人群体中很普遍。应优先使用组织学发育异常的痣这一术语，而非发育异常痣。
