Dermatopathology
The MPATH-Dx reporting schema for melanocytic proliferations and melanoma

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Background

The histologic diagnosis of melanoma and nevi can be subject to discordance and errors, potentially leading to inappropriate treatment and harm. Diagnostic terminology is not standardized, creating confusion for providers and patients and challenges for investigators.

Objective

We sought to describe the development of a pathology reporting form for more precise research on melanoma and a diagnostic-treatment mapping tool for improved patient care and consistency in treatment.

Methods

Three dermatopathologists independently reviewed melanocytic lesions randomly selected from a dermatopathology database. Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) reporting schema evolved from iterative case review and form revision.

Results

Differences in diagnostic thresholds, interpretation, and nomenclature contributed to development of the MPATH-Dx histology reporting form, which groups lesions by similarities in histogenesis and degrees of atypia. Because preliminary results indicate greater agreement regarding suggested treatments than for specific diagnoses, the diverse terminologies of the MPATH-Dx histology reporting form were stratified by commonalities of treatments in the MPATH-Dx diagnostic-treatment mapping scheme.

Limitations

Without transformative advances in diagnostic paradigms, the interpretation of melanocytic lesions frequently remains subjective.

Conclusions

The MPATH-Dx diagnostic-treatment mapping scheme could diminish confusion for those receiving reports by categorizing diverse nomenclature into a hierarchy stratified by suggested management interventions.

Section snippets

Methods

The institutional review board of the University of Washington approved this project. Three experienced melanocytic lesion pathologists comprised a reference panel, whose goal was to develop and iteratively test a histology reporting form for pathologists to use during slide review in the upcoming main study, and a treatment mapping scheme for reviewing and recording diagnoses of melanocytic lesions.

Development of the MPATH-Dx histology reporting form

For the goals of the upcoming main project, we developed a histology reporting form that would standardize the diagnoses for future participating pathologists. The development of the form was iterative and occurred during a 1-year period (Fig 1). It involved consensus building derived from concepts integrated into the MPATH-Dx histology reporting form. It became clear early on that each panel member uses a personalized set of nomenclatures in their interpretations; it was therefore decided to

Discussion

Our approach of iterative interpretation, review, and rereview of cases while revising the MPATH-Dx forms to ensure accurate capture of histologic criteria for the diagnosis and treatment of melanocytic lesions yielded a histology reporting form and a diagnostic-treatment mapping scheme. The MPATH-Dx histology reporting form may prove useful in population-based research on melanocytic lesions because it categorizes for researchers outside the field of dermatopathology a diversity of arcane

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    Supported by the National Cancer Institute, National Institutes of Health (RO1CA151306).

    Disclosure: Dr Barnhill believes he has no relevant conflicts of interest to declare but discloses that he has received a grant from Abbott Diagnostics. Drs Piepkorn, Elder, Knezevich, Carney, Reisch, and Elmore have no conflicts of interest to declare.

    The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.

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