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

Jason P. Lott, Joann G. Elmore*, Ge A. Zhao, Stevan R. Knezevich, Paul D. Frederick, Lisa M. Reisch, Emily Y. Chu, Martin G. Cook, Lyn M. Duncan, Rosalie Elenitsas, Pedram Gerami, Gilles Landman, Lori Lowe, Jane L. Messina, Martin C. Mihm, Joost J. van den Oord, Michael S. Rabkin, Birgitta Schmidt, Christopher R. Shea, Sook Jung YunGeorge X. Xu, Michael W. Piepkorn, David E. Elder, Raymond L. Barnhill, International Melanoma Pathology Study Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

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. Limitations This was a small sample size of experienced pathologists in a testing situation. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)356-363
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume75
Issue number2
DOIs
StatePublished - Aug 1 2016

Keywords

  • Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis
  • classification
  • diagnosis
  • dysplastic nevus
  • melanoma
  • nevus
  • pathology
  • variability
  • variation

ASJC Scopus subject areas

  • Dermatology

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