Wassenberg, R. (Roos) (2017) Expert revision of melanoma biopsies still indicated? A retrospective study on inter-observer variation in the histopathologic reporting of primary cutaneous melanoma of the head and neck. thesis, Medicine.
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Abstract
Objective. For patients with a primary cutaneous head and neck melanoma the pathologic parameters are crucial. The parameters are essential for staging, to determine the appropriate treatment and are the strongest predictors of outcome. Until now, the pathologic parameters remain dependent on the expertise of the individual pathologist. Therefore, inter-observer variation between pathologists is almost inevitable. Pathologists working at the Netherlands Cancer Institute (NKI) routinely review melanoma patients referred for treatment. The purpose of this study was to analyze the inter-observer variation of histopathological reports between the reports from the pathologist at the NKI versus reports from non-NKI general pathologist. This analysis is done of primary cutaneous head and neck melanomas. Study design. A retrospective observational patient file study of case series was conducted. A total of 483 cases of pathological features of primary cutaneous head and neck melanoma over a time period of 11 years (2005-2016) were compared. These cases were collected by the PALGA system (Pathologisch Anatomisch Landelijk Geautomatiseerd Archief), a national database for pathological biopsies. Methods. Two hundred ninety-six patients who underwent excision of a primary cutaneous head and neck melanoma were included. Patients were excluded due to a recurrent cutaneous head-neck melanoma, referring hospital outside the Netherlands, only a request for second opinion or due to >2 missing histopathologic parameters in NKI or non-NKI reports. Reports were collected from both referring general pathologists and the pathologists at NKI. All the reports were analyzed for patients demographics, tumor characteristics and histopathologic features in both the referring and NKI reports. The histopathologic features include the melanoma sub-type, Breslow thickness (BT), tumor mitotic rate (TMR) and ulceration. For these features the intraclass correlation coefficient and kappa score calculated the interobserver variation. Results. In 53.4% of the patients the histopathologic parameters were disconcordant. The kappa scores were 0.648 for sub-type, 0.775 for BT, 0.472 for TMR and 0.802 for ulceration. The intraclass correlation coefficient was 0.981 for BT. These results indicated a perfect interobserver agreement among the pathologist for the measurement of BT, a substantial agreement for subtype and ulceration and a moderate agreement for TMR. After NKI review in 38 patients (12.8%) recommended treatment policies were changed. The indication changed for proposed surgical excision margins in 26 cases (8.8%) and for scheduling sentinel lymph node biopsy (SLNB) in 14 reports (4.8%) after review by an NKI pathologist. Conclusion. Review by an expert NKI pathologist of histopathologic parameters of primary cutaneous head and neck melanoma leads to significant changes, with in some cases serious consequences for treatment planning. Due to continuous changes over the years in classification and staging system these histopathologic disconcordances are from great relevance.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultary supervisor: and Nijholt, I. M. and MD-PhD affiliation coordinator and Isala Zwolle |
| Supervisor name: | Daily supervisor: and Berger, D. MD head and neck surgery and Antoni van Leeuwenhoek and Extern supervisors: and Balm, Prof. A.J.M MD-PhD head and neck surgeon and Klop, W.M.C MD-PhD head and neck surgeon and Antoni van LeeuwenhoekD.Extern supervisors: and Balm, Prof. A.J.M MD-PhD head and neck surgeon and Klop, W.M.C MD-PhD head and neck surgeon and Antoni van Leeuwenhoek |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1102 |
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