ABSTRACT: Clinical information on histologic referral sheets is usually very limited, and particularly for inflammatory skin disorders, dermatopathologists often ask referring physicians for clinical correlation.
In this study we tested the value of clinicopathologic correlation in the histopathologic diagnosis of inflammatory skin disorders.
One-hundred biopsy specimens were digitalized and stored on 3 DVDs along with the clinical images. All cases were evaluated by 9 independent full-time dermatopathologists, initially without looking at the clinical pictures and subsequently after checking them. All diagnoses were finally compared with the "reference" diagnosis established in Graz, Austria, and the results were statistically analyzed.
After evaluation of the clinical images, the number of dermatopathologists making a correct diagnosis was increased in 70 cases, unchanged in 25 cases, and decreased in 5 cases. The total number of correct diagnoses increased from 332 (diagnoses before evaluation of clinical pictures) to 481 (diagnoses after evaluation of clinical pictures), with a 16.6% increase in the total.
The computerized setting is different from real-life dermatopathology and physical examination of patients.
Our study clearly shows that clinical pictures should be added to biopsy request slips of inflammatory skin disorders whenever possible, as they allow a better interpretation of histopathologic findings.
Journal of the American Academy of Dermatology 10/2010; 63(4):647-52. · 3.99 Impact Factor
The American Journal of dermatopathology 09/2009; 31(8):803-5. · 1.30 Impact Factor
ABSTRACT: We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).
Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.
In D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23). Most diagnostic changes were in D2 (age/sex/location).
The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.
PLoS ONE 01/2009; 4(4):e5375. · 4.09 Impact Factor
Journal of Cutaneous Pathology 03/2006; 33(2):156-9. · 1.56 Impact Factor
Journal der Deutschen Dermatologischen Gesellschaft 05/2005; 3(4):309-11. · 1.47 Impact Factor
American Journal of Dermatopathology 11/2004; 26(5):439-40. · 1.20 Impact Factor