INTERCLINICIAN AGREEMENT ON THE RECOGNITION OF SELECTED GROSS MORPHOLOGICAL FEATURES OF PIGMENTED LESIONS - STUDIES OF MELANOCYTIC NEVI-V

被引:25
作者
BARNHILL, RL
ROUSH, GC
ERNSTOFF, MS
KIRKWOOD, JM
机构
[1] CANC PREVENT RES INST,NEW YORK,NY
[2] MASSACHUSETTS GEN HOSP,DERMATOL SERV,BOSTON,MA 02114
[3] HARVARD UNIV,SCH MED,BOSTON,MA 02115
[4] UNIV PITTSBURGH,SCH MED,DEPT MED,DIV MED ONCOL,PITTSBURGH,PA 15261
关键词
D O I
10.1016/0190-9622(92)70023-9
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background: Since the late 1970s clinical criteria for dysplastic melanocytic nevi (DMN) have been proposed and discussed. However, to our knowledge, no rigorous quantitative evaluation of the ability of examiners to agree on the gross morphologic features ascribed to DMN or atypical melanocytic lesions in general has been conducted. Objective: The purpose of the study was to determine rates of interclinician agreement for recognizing seven clinical features associated with melanocytic lesions. Methods: The gross morphologic features of 156 pigmented lesions, judged to be the clinically most atypical, from 156 consecutively examined patients with cutaneous melanoma were analyzed. Independent of the other clinicians' examinations, four physicians (two medical oncologists, one internist-epidemiologist, and one dermatologist-dermatopathologist) recorded seven gross morphologic features of the most atypical pigmented lesion on each patient. For up to 122 patients, the rates of interobserver agreement on recognizing these clinical features were measured by intraclass correlation. Results: Among the clinical features assessed, the examiners noted macular components in 85.7% to 96.3% of lesions, asymmetry in 47.2% to 79.5%, irregular borders in 55.1% to 80.2%, ill-defined borders in 40.1% to 83.9%, and haphazard color in 40.8% to 73.9% of lesions. Despite this range of variance among examiners, there were statistically significant rates of interclinician agreement for the recognition of the latter features. There was less agreement in assessing individual colors within lesions. Conclusion: These findings substantiate that certain gross morphologic features routinely used in the clinical evaluation of melanocytic lesions can be recognized with a significant degree of reliability.
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页码:185 / 190
页数:6
相关论文
共 12 条
[1]   CORRELATION OF HISTOLOGIC ARCHITECTURAL AND CYTOPLASMIC FEATURES WITH NUCLEAR ATYPIA IN ATYPICAL (DYSPLASTIC) NEVOMELANOCYTIC NEVI [J].
BARNHILL, RL ;
ROUSH, GC ;
DURAY, PH .
HUMAN PATHOLOGY, 1990, 21 (01) :51-58
[2]  
BARNHILL RL, 1988, PLAST RECONSTR SURG, V81, P230
[3]   HOW WELL DO PHYSICIANS RECOGNIZE MELANOMA AND OTHER PROBLEM LESIONS [J].
CASSILETH, BR ;
CLARK, WH ;
LUSK, EJ ;
FREDERICK, BE ;
THOMPSON, CJ ;
WALSH, WP .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1986, 14 (04) :555-560
[4]  
ELDER DE, 1987, PIGMENT CELL, V8, P1
[5]   PREVENTION OF MELANOMA BY RECOGNITION OF ITS PRECURSORS [J].
FITZPATRICK, TB ;
RHODES, AR ;
SOBER, AJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 312 (02) :115-116
[6]   CLINICAL-DIAGNOSIS OF DYSPLASTIC MELANOCYTIC NEVI - A CLINICOPATHOLOGICAL CORRELATION [J].
KELLY, JW ;
CRUTCHER, WA ;
SAGEBIEL, RW .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1986, 14 (06) :1044-1052
[7]   MISINTERPRETATION AND MISUSE OF THE KAPPA-STATISTIC [J].
MACLURE, M ;
WILLETT, WC .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1987, 126 (02) :161-169
[8]   DIAGNOSIS OF THE DYSPLASTIC NEVUS IN DIFFERENT POPULATIONS [J].
ROUSH, GC ;
BARNHILL, RL ;
DURAY, PH ;
TITUS, LJ ;
ERNSTOFF, MS ;
KIRKWOOD, JM .
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY, 1986, 14 (03) :419-425
[9]  
ROUSSEAU GS, 1988, MILLENARIANISM MESSI, P85
[10]   BENIGN MELANOCYTIC NEVI AS A RISK FACTOR FOR MALIGNANT-MELANOMA [J].
SWERDLOW, AJ ;
ENGLISH, J ;
MACKIE, RM ;
ODOHERTY, CJ ;
HUNTER, JAA ;
CLARK, J ;
HOLE, DJ .
BRITISH MEDICAL JOURNAL, 1986, 292 (6535) :1555-1559