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Factors associated with use of immunohistochemical markers in the histopathological diagnosis of cutaneous melanocytic lesions
Author(s) -
May Caitlin J.,
Piepkorn Michael W.,
Knezevich Stevan R.,
Elder David E.,
Barnhill Raymond L.,
Lee Annie C.,
Flores Martiniano J.,
Kerr Kathleen F.,
Reisch Lisa M.,
Elmore Joann G.
Publication year - 2020
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.13736
Subject(s) - dermatopathology , medicine , concordance , kappa , pathology , cohen's kappa , immunohistochemistry , dermatology , anatomical pathology , biopsy , philosophy , linguistics , machine learning , computer science
Background Melanocytic tumors are often challenging and constitute almost one in four skin biopsies. Immunohistochemical (IHC) studies may assist diagnosis; however, indications for their use are not standardized. Methods A test set of 240 skin biopsies of melanocytic tumors was examined by 187 pathologists from 10 US states, interpreting 48 cases in Phase I and either 36 or 48 cases in Phase II. Participant and diagnosis characteristics were compared between those who reported they would have ordered, or who would have not ordered IHC on individual cases. Intraobserver analysis examined consistency in the intent to order when pathologists interpreted the same cases on two occasions. Results Of 187 participants interpreting 48 cases each, 21 (11%) did not request IHC tests for any case, 85 (45%) requested testing for 1 to 6 cases, and 81 (43%) requested testing for ≥6 cases. Of 240 cases, 229 had at least one participant requesting testing. Only 2 out of 240 cases had more than 50% of participants requesting testing. Increased utilization of testing was associated with younger age of pathologist, board‐certification in dermatopathology, low confidence in diagnosis, and lesions in intermediate MPATH‐Dx classes 2 to 4. The median intraobserver concordance for requesting tests among 72 participants interpreting the same 48 cases in Phases I and II was 81% (IQR 73%‐90%) and the median Kappa statistic was 0.20 (IQR 0.00, 0.39). Conclusion Substantial variability exists among pathologists in utilizing IHC.