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Reliability of skin biopsy pathology
1Department of Family Medicine, University of Washington School of Medicine, Seattle 98195.
The Journal of the American Board of Family Practice
|September 1, 1994
Summary
Skin biopsy reliability is high, but disagreements, especially for melanoma, highlight the need for second opinions when diagnoses don't match clinical impressions or when pathologists are uncertain.
Area of Science:
- Dermatology
- Pathology
- Medical Diagnostics
Background:
- Histologic examination of skin biopsies is the gold standard for diagnosing skin diseases.
- Therapy and follow-up decisions rely heavily on accurate biopsy diagnoses.
- The reliability of skin biopsy diagnoses made by primary care providers (family physicians and physician assistants) was investigated.
Purpose of the Study:
- To assess the reliability of skin biopsy diagnoses submitted by family physicians and physician assistants.
- To evaluate interrater agreement between community-based pathology groups and a dermatopathologist.
Main Methods:
- A dermatopathologist re-evaluated 119 randomly selected skin biopsies.
- These biopsies were originally diagnosed by a community-based pathology group.
- The study period covered 4.5 years and included biopsies from a large health maintenance organization.
Main Results:
- Excellent interrater agreement was observed, with a weighted kappa of 0.83.
- There were 107 exact matches and 9 mismatches (3 premalignant, 6 benign).
- Disagreements occurred in three melanoma cases, with one initially diagnosed as squamous cell cancer.
Conclusions:
- While overall skin biopsy interpretation shows excellent agreement, discrepancies in melanoma diagnoses persist.
- Disagreements in melanoma cases align with previous findings of poor interrater agreement for early melanomas.
- Family physicians should seek second opinions when histopathologic diagnoses conflict with clinical findings or when pathologists express uncertainty.