The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms.
BACKGROUND
We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).


METHODS
Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.


RESULTS
In D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23). Most diagnostic changes were in D2 (age/sex/location).


CONCLUSIONS
The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.
Ferrara
Gerardo
G
Department of Pathology, Gaetano Rummo General Hospital, Benevento, Italy.
Argenyi
Zsolt
Z
Argenziano
Giuseppe
G
Cerio
Rino
R
Cerroni
Lorenzo
L
Di Blasi
Arturo
A
Feudale
Elisa A A
EA
Giorgio
Caterina M
CM
Massone
Cesare
C
Nappi
Oscar
O
Tomasini
Carlo
C
Urso
Carmelo
C
Zalaudek
Iris
I
Kittler
Harald
H
Soyer
H Peter
HP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D016208:Databases, Factual; D046169:Dermoscopy / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D012878:Skin Neoplasms / Q000175:diagnosis*; D055815:Young Adult