title: Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group.
abstract: BACKGROUND
  Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care.
  
  
  OBJECTIVE
  We sought to evaluate the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) scheme, a 5-category classification system for melanocytic lesions.
  
  
  METHODS
  Participants (n = 16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when necessary, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Interrater agreement and correlation between MPATH-Dx categorization and treatment suggestions were evaluated.
  
  
  RESULTS
  Most participants were board-certified dermatopathologists (n = 15), age 50 years or older (n = 12), male (n = 9), based in the United States (n = 11), and primary academic faculty (n = 14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement after MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 (95% confidence interval 0.68-0.71) and 0.72 (95% confidence interval 0.71-0.73), respectively, whereas correlation between MPATH-Dx categorization and treatment suggestions was 0.91.
  
  
  CONCLUSIONS
  This was a small sample size of experienced pathologists in a testing situation.
  
  
  CONCLUSIONS
  Varying diagnostic nomenclature can be classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care.
authors.affiliation: Cornell Scott-Hill Health Center, New Haven, Connecticut.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Lott
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington. Electronic address: jelmore@u.washington.edu.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.affiliation: Division of Dermatology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Ge A
authors.initials: GA
authors.lastname: Zhao
authors.affiliation: Pathology Associates, Clovis, California.
authors.forename: Stevan R
authors.initials: SR
authors.lastname: Knezevich
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Reisch
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Emily Y
authors.initials: EY
authors.lastname: Chu
authors.affiliation: University of Surrey Division of Clinical Medicine, Surrey, United Kingdom.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Cook
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Duncan
authors.affiliation: Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Pedram
authors.initials: P
authors.lastname: Gerami
authors.affiliation: Department of Pathology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: Gilles
authors.initials: G
authors.lastname: Landman
authors.affiliation: Department of Pathology and Dermatology, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan.
authors.forename: Lori
authors.initials: L
authors.lastname: Lowe
authors.affiliation: Departments of Anatomic Pathology and Cutaneous Oncology, Moffitt Center, and Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, Florida.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mihm
authors.affiliation: Department of Pathology, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Joost J
authors.initials: JJ
authors.lastname: van den Oord
authors.affiliation: Rabkin Dermatopathology Laboratory PC, Tarentum, Pennsylvania.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rabkin
authors.affiliation: Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Section of Dermatology, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Shea
authors.affiliation: Department of Dermatology, Chonnam National University School of Medicine, Gwangju, Korea.
authors.forename: Sook Jung
authors.initials: SJ
authors.lastname: Yun
authors.affiliation: Department of Pathology and Lab Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: George X
authors.initials: GX
authors.lastname: Xu
authors.affiliation: Division of Dermatology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Piepkorn
authors.affiliation: Department of Pathology and Lab Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: David E
authors.initials: DE
authors.lastname: Elder
authors.affiliation: Department of Pathology, Institut Curie and Faculty of Medicine, University of Paris Descartes, Paris, France.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Barnhill
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008545:Melanoma / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D012878:Skin Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D009626:Terminology as Topic
keywords: Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis; classification; diagnosis; dysplastic nevus; melanoma; nevus; pathology; variability; variation