Meyer L J, Piepkorn M, Goldgar D E, Lewis C M, Cannon-Albright L A, Zone J J, Skolnick M H
Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, USA.
J Am Acad Dermatol. 1996 Apr;34(4):618-25. doi: 10.1016/s0190-9622(96)80061-2.
The clinical features attributed to atypical (formerly ¿dysplastic") nevi and to the atypical multiple mole melanoma syndrome have been used in clinical practice, as well as experimentally, to assign melanoma risk. Little information is available, however, on the interobserver reliability in assessing those features.
Our purposes were to quantify interobserver and intraobserver concordances in recognizing certain atypical characteristics of nevi and to correlate the clinical assessments with the histologic characteristics.
Three observers evaluated clinical photographs of 100 pigmented lesions (predominantly melanocytic nevi, with some lentigines and seborrheic keratoses) from 95 subjects, of whom 85 were family members of four multiple melanoma kindreds and 10 were spouses. Each lesion was rated for border irregularity, color variegation, surface contour irregularity, pigment diffusion, and macularity versus papularity. Predictions were made as to the histologic diagnoses and presence of melanocytic atypia for those lesions judged to be nevi.
The pair-wise concordances before agreement on specific criteria were quantified by kappa statistics, which indicated slight to fair agreement in judging the atypical clinical characteristics; concordances increased to moderate levels after consensus development of criteria for color variegation and assessment of macularity, but agreement on the other features remained limited. Whereas macularity and color variegation did correlate somewhat with higher grades of histologic atypia, correlations were generally low between the clinical and histologic diagnoses.
There is limited interobserver reliability in the clinical assessment of nevus atypia, although correlations do exist between some atypical characteristics and grades of histologic atypia. Because of the low concordances, the clinical discrimination of the melanoma-associated atypical nevus phenotype should rely more on quantitative aspects of the trait, such as total numbers or maximal sizes of nevi, rather than on the subjective determinations of atypia.
非典型（以前称为“发育异常”）痣和非典型多发性痣黑色素瘤综合征的临床特征已应用于临床实践以及实验中，以评估黑色素瘤风险。然而，关于评估这些特征时观察者间的可靠性，目前所知甚少。
我们的目的是量化观察者间和观察者内对痣某些非典型特征识别的一致性，并将临床评估与组织学特征相关联。
三名观察者评估了95名受试者的100个色素沉着病变（主要是黑素细胞痣，还有一些雀斑样痣和脂溢性角化病）的临床照片，其中85名是四个多发性黑色素瘤家族的家庭成员，10名是配偶。对每个病变的边界不规则性、颜色斑驳、表面轮廓不规则性、色素扩散以及斑疹与丘疹性进行评分。对那些被判定为痣的病变进行组织学诊断和黑素细胞非典型性存在情况的预测。
在就具体标准达成一致之前，通过kappa统计量对两两一致性进行了量化，结果表明在判断非典型临床特征方面一致性为轻微到一般；在就颜色斑驳标准和斑疹评估达成共识后，一致性提高到中等水平，但在其他特征上的一致性仍然有限。虽然斑疹和颜色斑驳与较高等级的组织学非典型性有一定相关性，但临床和组织学诊断之间的相关性总体较低。
在痣非典型性的临床评估中，观察者间的可靠性有限，尽管一些非典型特征与组织学非典型性等级之间确实存在相关性。由于一致性较低，黑色素瘤相关非典型痣表型的临床鉴别应更多地依赖于该特征的定量方面，如痣的总数或最大尺寸，而不是非典型性的主观判定。
