Article

Clinicopathological consistency in skin disorders: A retrospective study of 3949 pathological reports

Authors:
  • University of Health Sciences Haydarpasa Numune Training and Research Hospital
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Abstract

Although the clinicopathological approach plays an important role in skin disorder diagnoses, few studies have evaluated the consistency between clinical and histopathological diagnoses of skin disorders. We sought to investigate the consistency, and factors affecting consistency, between clinical diagnoses and pathological diagnoses in patients with skin disorders referred for biopsy by dermatologists. We retrospectively examined 3949 pathological reports of biopsy specimens, between 1999 and 2008. The relationships between clinical and pathological diagnoses were studied in 4 groups, namely: (1) definite pathological diagnoses consistent with the clinical diagnoses, (2) descriptive pathological diagnoses consistent with the clinical diagnoses, (3) definite pathological diagnoses inconsistent with the clinical diagnoses, and (4) descriptive pathological diagnoses inconsistent with the clinical diagnoses. The first two groups show consistency, whereas the latter two groups show inconsistency between the diagnoses. The pathological diagnoses were consistent with the clinical diagnoses in 3034 biopsy reports (76.8%), and they were inconsistent in 915 reports (23.2%). In all types of skin disorders, clinicopathological consistency was higher in patients with sufficient clinical descriptive information. No correlation was observed between clinicopathological consistency and biopsy type, number of clinical diagnoses, or specifying the location of disease. Disease duration was shorter in the biopsy reports showing clinicopathological consistency. Moreover, a statistically significant increase was found in clinicopathological consistency for inflammatory dermatoses, when pathologists evaluated the specimens with clinical diagnoses, in comparison with blind evaluation. The retrospective nature of the study might have resulted in a loss of data. In a dermatology clinic setting, providing sufficient clinical descriptive information for pathology requisition forms increases the probability of making an accurate diagnosis.

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... Previous reports have validated the skin biopsy and shown that its usefulness is optimized by the addition of appropriate clinical information (clinicopathologic correlation). [1][2][3][4][5] Prior reviews have sought to categorize the outcomes of skin biopsy in terms of its contribution to a final diagnosis. 2 The inflammatory dermatoses represent a subgroup that presents diagnostic difficulties from both a clinical and a histopathological perspective. ...
... [1][2][3][4][5] Prior reviews have sought to categorize the outcomes of skin biopsy in terms of its contribution to a final diagnosis. 2 The inflammatory dermatoses represent a subgroup that presents diagnostic difficulties from both a clinical and a histopathological perspective. 6 This study examines a particularly challenging subgroup of the inflammatory dermatoses, that is, perivascular dermatitis (as defined by the Ackerman algorithm 7 ). ...
... Probably of greatest value, 13% of the biopsies provided a novel diagnosis, not considered clinically. 1 For the subgroup of inflammatory dermatoses, clinical information is of particular value. 1,2 An important difference between this study examining perivascular dermatitis and that of the study by Rajaratnam et al is that the biopsy results that they reviewed were selected based on the clinical differential diagnosis (ie, those that included an inflammatory condition) and not on a histopathological diagnosis of an inflammatory condition, as in this study. Another difference between the studies was the assessment of "blinded" histopathological opinion (ie, with no clinical information given) as compared with the assessment of histopathology with the benefit of clinical data. ...
Article
Skin biopsy is a commonly used and valuable tool in the diagnosis of diseases of the skin. The inflammatory dermatoses are a subgroup that presents diagnostic difficulties from both a clinical and a histopathological perspective. This study examines a particularly challenging subgroup of the inflammatory dermatoses, that is, perivascular dermatitis. The final conclusions of the histological report of 163 biopsies considered to fall into the perivascular dermatitis group were examined, and the value skin biopsy added in the final diagnosis of each case was evaluated. The 2 most valuable potential outcomes of the histopathological report: consistent with clinical diagnosis with strong evidence of a specific diagnosis and new, unexpected, helpful, specific diagnosis, occurred in 40 reports (24.54%).
... Aslan et al., 3 in their retrospective study to analyze the clinicopathological consistency in skin disorders in 3949 pathology reports, observed that providing a good clinical description in pathology requisition forms increased the diagnostic accuracy. Rajaratnam et al. 4 observed that accurate diagnoses were made in 55% of cases by pathologists when they were blind-folded about the clinical details of the patients, and the diagnostic accuracy increased to 78% when they were provided with the necessary clinical information. ...
... Minor discordance and discordance were seen in 7.6% and 30.9% biopsies, respectively. Aslan et al. 3 found 76.8% of reports to be clinicopathologically consistent and 23.2% reports to be clinicopathologically inconsistent. Other studies have reported diagnostic accuracy rates varying between 44% and 96.5%. ...
... Other studies have reported diagnostic accuracy rates varying between 44% and 96.5%. [6][7][8][9][10][11][12][13] However, these were mainly confined to solitary lesions, benign tumors, and suspicious pigmented lesions, [6][7][8][9][10][11][12][13] in contrast to our study and the study by Aslan et al., 3 wherein all types of dermatological diseases were analyzed. ...
Article
Background Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome.Objectives The aim of this study was to retrospectively assess the quality of data included in the pathology request forms and reports and to assess the level of clinicopathological correlation in the reported biopsy specimens.Methods We retrospectively analyzed 3006 histopathology request forms and reports of skin, mucosal, and nail biopsies to assess the quality of data included in them and assessed the level of clinicopathological correlation in these biopsies. Two hundred discordant histopathology slides were randomly reviewed by a pathologist in the presence of a dermatologist to analyze the causes for discordance.ResultsThe pathological diagnosis was concordant with clinical diagnosis in 1798 (59.8%) biopsies, partially concordant in 228 (7.6%) biopsies, and discordant in 929 (30.9%) biopsies. In a clinicopathologically concordant category, the duration for reporting the biopsies was significantly shorter, and the definitive pathologist's diagnosis was frequently mentioned. Of the 200 discordant slides reviewed randomly by a pathologist in the presence of a dermatologist, 7.5% slides afterward turned out to be consistent and 15% partially consistent with the diseases in doubt.Conclusion Several deficits were identified that need to be rectified to improve the diagnostic accuracy of skin biopsy. A portion of discordant slides showing features compatible with the disease when reviewed by a pathologist and dermatologist together emphasizes the importance of a joint review by both in doubtful cases.
... In a retrospective study of clinicopathological consistency in 3949 skin biopsy reports, the diagnostic accuracy rate was 76.8%. [6] A similar retrospective audit of skin biopsies investigating all types of skin diseases arrived at a clinicopathological concordance of 59.8%. [7] Prior studies performed mainly in isolated groups of skin disorders such as benign and malignant skin tumors arrived at a concordance rate ranging from 44% to 96.5%. ...
... [3][4][5][8][9][10][11][12] Many of the previous research on clinicopathological consistency have supported the importance of providing adequate clinical information to the pathologist. Aslan et al. [6] observed a significant decrease in clinicopathological concordance rate when biopsy specimens were re-examined without clinical diagnosis. ...
... Aslan et al. [6] observed the highest concordance in connective tissue diseases (96.8%), followed by metabolic diseases (95.1%), bullous diseases (94.6%), inflammatory dermatoses (93.9%), and hereditary diseases (92.5%). In contrast, our study showed a much lower degree of correlation in connective tissue diseases (68.4%) and metabolic diseases (50.0%). ...
... Aslan et al., 3 in their retrospective study to analyze the clinicopathological consistency in skin disorders in 3949 pathology reports, observed that providing a good clinical description in pathology requisition forms increased the diagnostic accuracy. Rajaratnam et al. 4 observed that accurate diagnoses were made in 55% of cases by pathologists when they were blind-folded about the clinical details of the patients, and the diagnostic accuracy increased to 78% when they were provided with the necessary clinical information. ...
... Minor discordance and discordance were seen in 7.6% and 30.9% biopsies, respectively. Aslan et al. 3 found 76.8% of reports to be clinicopathologically consistent and 23.2% reports to be clinicopathologically inconsistent. Other studies have reported diagnostic accuracy rates varying between 44% and 96.5%. ...
... Other studies have reported diagnostic accuracy rates varying between 44% and 96.5%. [6][7][8][9][10][11][12][13] However, these were mainly confined to solitary lesions, benign tumors, and suspicious pigmented lesions, [6][7][8][9][10][11][12][13] in contrast to our study and the study by Aslan et al., 3 wherein all types of dermatological diseases were analyzed. ...
Article
Context: Dermatoscopy has been used recently for identifying the specific features of onychomycosis. Very few studies have used it as a diagnostic tool. Our study highlights the specific patterns in different clinical types of onychomycosis and the novel features that have never been reported previously. Aims: To study the dermatoscopic patterns in patients with onychomycosis and determine the sensitivity, specificity, positive, and negative predictive values of the different features. Study design: A cross-sectional study. Materials and method: Dermatoscopic picture using dinolite video dermatoscope was taken in patients diagnosed with onychomycosis either with a positive KOH, culture, and/or PAS. Result: A total of 80 patients were included. Onychomycosis was identified in 68 individuals. Clinically, 73.52% presented with distal lateral subungual onychomycosis (DLSO) and 26.47% had total dystrophic (TD). PAS was positive in 85.29% of patients, KOH in 75%, and culture in 66.17%. Trichophyton species were isolated in 53.33%, whereas Candida species in 40% of patients. Dermatoscopic features were seen in all 68 patients (100%). The most common finding in decreasing order includes spike pattern, ruin appearance, distal irregular terminations (DIT), longitudinal striations, chromonychia, focal homogeneous opacities, microsplitting, and uniform homogeneous pattern. Three novel patterns were observed: homogeneous opacity with a-z pattern border, microsplitting in a Christmas tree pattern, and focal homogeneous opacities. Conclusion: To our knowledge, this is the first study conducted in northeast India where dermatoscopy was used as a diagnostic tool and it was found to have the highest sensitivity. New features that have not been described before have been identified.
... Few studies have been undertaken to evaluate the utility of skin biopsies in the past, with the majority focusing on a specific disease entity. Aslan et al. found the clinicopathological agreement to be 76.8% whereas Balasubramanian et al. found the same to be 59.8% and partial concordance in their study was recorded to be 7.6% [1,6]. In a Malaysian experience of 400 biopsies, Yap et al. recorded a clinicopathological concordance of 86.8% [7]. ...
... The clinical suspicion of malignancy was raised in 49 cases out of which 28 were confirmed on histopathology (57.15%). Another Indian study found the agreement to be 52.7% as compared to 89.2% in Western literature [1,6]. In this group, the most commonly encountered malignancy was basal cell carcinoma (BCC), which showed a concordance of 79.16%. ...
... In this group, the most commonly encountered malignancy was basal cell carcinoma (BCC), which showed a concordance of 79.16%. A similar percentage was noted in previous studies for BCC concordance ranging from 92.6% to 85.4% [6,14]. We received only one case of melanoma that had the histopathological features of the same. ...
Article
Full-text available
Introduction To determine the spectrum of diseases and the level of clinicopathological concordance in skin biopsies received over a period of one year. Methods A total of 2216 skin biopsy cases received over a period of one year at a tertiary care center were retrospectively analyzed. The cases were further divided into further categories in levels of concordance based on the agreement between the clinical and histopathological diagnosis rendered. Results Of the cases, 61.01% showed clinicopathological concordance. Cases with a descriptive pathological diagnosis, not matching the clinical diagnosis, constituted 31.54%, whereas 4.02% of cases had a definitive pathological diagnosis, which was discordant with the clinical differentials; 3.29% biopsies were inadequate. Conclusion This study highlights the clinicopathological concordance in all the biopsies received from dermatology. It emphasizes the importance of skin biopsies in arriving at the diagnosis. However, it is a tool that must be used judiciously. Skin biopsies are also pivotal in flagging malignancies that may mimic benign lesions.
... 4 Although both clinical and histopathological data are critical for the proper diagnosis of several skin disorders, few studies have examined concordance or the agreement between clinical and histopathological diagnoses of skin disorders. 1,[4][5][6] In these studies, agreement of both diagnoses has ranged between 67% and 87%, depending on the study definition of concordance and whether clinical data were available to the pathologist. 1,[4][5][6][7] Additionally, several biopsy-related factors can influence the diagnostic yield of a skin biopsy. ...
... 1,[4][5][6] In these studies, agreement of both diagnoses has ranged between 67% and 87%, depending on the study definition of concordance and whether clinical data were available to the pathologist. 1,[4][5][6][7] Additionally, several biopsy-related factors can influence the diagnostic yield of a skin biopsy. 8,9 Insufficient clinical information on the skin biopsy requisition form is a common finding and is considered an important challenge for accurate histopathological diagnosis. ...
... 7,14,15 Few studies have provided group-specific clinicopathological concordance of skin diseases diagnosed by dermatologists. 1,5 Additionally, such concordance has never been examined locally or regionally. The objectives of the current study were to examine the clinicopathological concordance of different skin diseases diagnosed by dermatologists at a tertiary care setting and to examine the effect of biopsy-related factors, various differential diagnoses, and specialization of the pathologist on such concordance. ...
Article
Full-text available
Background: The accuracy of clinical diagnoses of skin diseases has not been researched in Saudi Arabia. Objectives: Assess concordance between the histopathological and clinical diagnosis in skin diseases. Design: Retrospective. Setting: Academic tertiary care center. Methods: Demographic, clinical and pathological data were collected from the medical record for the period 1997-2013. Main outcome measures: Concordance between the pathological and clinical diagnosis. Sample size: 4268 cases. Results: Of 4268 biopsies, 2440 (58.1%) were females. The mean age (SD) of patients was 36.9 (17.8) years. The three most common locations from which skin biopsies were retrieved in descending order were the lower extremity (1123; 29.1%), head, neck, scalp and hair (1033; 26.7%) and trunk (853; 22.1%). Overall concordance was 75.9% (partial concordance 47.6%, full concordance 28.3%). Biopsies from the oral mucosa and lips had the lowest concordance (overall 58.5%, full 26.4%) at P=.004. Overall concordance was highest for the following three diagnoses: malignant neoplasms, 88%; vesiculobullous diseases 87%; urticarias, erythemas, and purpuras 87%. Conclusion: There is considerable variability in concordance among different histopathological diagnoses. The full concordance between the clinical diagnosis and the pathological diagnosis is low. This is a reflection of the fact that the biopsies were obtained only in cases where the clinical diagnosis was a dilemma. Limitations: Single center, retrospective, incomplete medical records, low percentage of biopsies were assessed by dermatopathologists. Conflict of interest: None.
... The degree of spongiosis depends on the stage of lesions, with more vesiculation in the acute phase and irregular epidermal hyperplasia in the chronic phase ( Figure 3). The diagnosis of inflammatory skin diseases is heavily dependent on clinical signs [36]. However, clinicians sometimes face a dilemma when there are characteristics in between AD and PSO. ...
... However, clinicians sometimes face a dilemma when there are characteristics in between AD and PSO. It is especially problematic when irritation or partial treatment is ac- The diagnosis of inflammatory skin diseases is heavily dependent on clinical signs [36]. However, clinicians sometimes face a dilemma when there are characteristics in between AD and PSO. ...
Article
Full-text available
Psoriasis (PSO) and atopic dermatitis (AD) were once considered to be mutually exclusive diseases, but gradually regarded as a spectrum of disease. Shared genetic loci of both diseases were noted in some populations, including Chinese. Shared immunopathogenesis involving Th17, Th1, Th22 cells, or even IL-13 was found in certain stages or phenotypes. This review discusses the overlapping genetic susceptibility, shared cytokines, immune-mediated comorbidities, and clinical presentations. Overlapping conditions could be classified into mainly PSO lesions with AD features or vice versa, concomitant PSO and AD, or disease transformation as a result of biologics treatment.
... 1,2 The quality, completeness, and accuracy of the clinical information on the SBRF influences the dermatopathologist's ability to make an accurate and timely histopathologic diagnosis, clinically meaningful histologic interpretation, and appropriate treatment recommendations for the clinician. [2][3][4] Previous research regarding clinicpathological consistency has suggested the clinical diagnostic accuracy rates of dermatologists were significantly higher than physicians of other disciplines. 3,5 Despite the comparative higher accuracy of clinical diagnoses on SBRFs by dermatologists, data has demonstrated that the ideal amount and quality of information on SBRFs for histopathological interpretation is often incomplete or absent and impedes the ability of dermatopathologists to make an accurate and efficient diagnostic decision. ...
... [2][3][4] Previous research regarding clinicpathological consistency has suggested the clinical diagnostic accuracy rates of dermatologists were significantly higher than physicians of other disciplines. 3,5 Despite the comparative higher accuracy of clinical diagnoses on SBRFs by dermatologists, data has demonstrated that the ideal amount and quality of information on SBRFs for histopathological interpretation is often incomplete or absent and impedes the ability of dermatopathologists to make an accurate and efficient diagnostic decision. 1, 6,7 An increasing number of SBRFs are completed electronically because many practices have adopted electronic medical records (EMR). ...
Article
Full-text available
Background: There are shortcomings in the quality and accuracy of submitted clinical information on skin biopsy requisition forms (SBRFs). Most SBRFs are completed via electronic medical records (EMR), and the effect of this on the work flow and the quality of submitted clinical information must be evaluated to identify targets in clinician-dermatopathologist communication for improvement.Objective: This review of the literature explored how SBRFs are currently handled by clinicians in the context of EMR, barriers to effective clinician-dermatopathologist communication, and suggestions for improvement.Methods: A literature search was conducted on Medline, Cinahl, and Scopus including the keywords of dermatology*, dermapatholog*, dermatopathology*, and requisition*. 20 articles were retrieved. 17 articles were included from this search and from cross-referencing articles.Results: This review reaffirmed the inadequacy of clinical information provided to dermatopathologists. Standardization of and formal education in completing SBRFs, along with dermatopathologist access to information and images via shared EMR may improve histopathologic interpretation of specimens and allow for cost-effective patient care.Limitations: This review was restricted to the English language. Previous studies have primarily been retrospective study designs and survey studies.Conclusion: The development of user-friendly standardized SBRFs with validated criteria are necessary. Clinician awareness of how to appropriately convey information and terminology on the SBRF may significantly improve the work flow of both clinicians and dermatopathologists and patient outcomes.
... P revious studies of clinicopathological consistency compared the accuracy of the preoperative diagnoses of dermatologists with those of physicians from other disciplines, such as general surgeons, plastic surgeons, family practice physicians, orthopedists, and internal medicine practitioners. [1][2][3][4][5] These studies asserted that the clinical diagnostic accuracy rates of dermatologists were significantly higher than those of physicians from other disciplines. The accuracy of diagnosis of skin lesions has important outcomes in treatment selection and prioritization of treatment. ...
... Previous research on clinicopathological consistency compared the accuracy of preoperative diagnoses by dermatologists with those of physicians from other disciplines, such as general surgeons, plastic surgeons, family practice physicians, orthopedists, and internal medicine practitioners. [1][2][3][4][5] Sellheyer and Bergfeld assessed the diagnostic abilities of non-dermatologist physicians (family practice physicians, plastic, general, and orthopedic surgeons, internists, and pediatricians) who performed various types of skin biopsies and compared them with those of dermatologists. A total of 4,451 cases were analyzed. ...
Article
Background: The accuracy of the diagnosis of skin lesions has an important effect in outcomes in treatment selection and prioritization of the treatment. Objective: To assess the effect of preoperative evaluations by dermatologists on the diagnostic accuracy of plastic surgeons. Materials and methods: A retrospective analysis was performed on 1,146 biopsies that were excised by plastic surgeons in our secondary State Hospital. The histopathologic diagnoses were divided into 2 groups according to the preoperative dermatological evaluation, with Group 1 being the lesions that were evaluated by a dermatologist before excision and Group 2 being the lesions that were not evaluated by a dermatologist before excision. The sensitivity and positive predictive values (PPVs) were calculated and compared between the 2 groups using Fisher exact test. Results: The PPVs of the malignant lesions of Groups 1 and 2 were 53.8% and 25.0%, respectively (p = .001). When Group 1 was contrasted with Group 2, the PPVs for the premalignant lesions were 71.4% and 46.8%, respectively (p = .015). The PPV for the benign lesions was 86.3% in Group 1 and 72.6% in Group 2 (p < .001). Conclusion: This study demonstrated that the diagnostic accuracy of plastic surgeons was affected positively by preoperative evaluations by a dermatologist.
... Deri biyopsisi, dermatolojide tanı amacı ile en sık kullanılan yöntemlerden biridir [3]. Bunun yanında patolojik incelemede doğru ve hızlı teşhis için klinisyen tarafından verilecek olan iyi bir klinik bilgi klinikopatolojik korelasyon açısından önem taşımaktadır [4]. Biz bu çalışmada klinisyen tarafından belirlenen ön tanıların klinikopatolojik korelasyondaki önemini belirlemeyi amaçladık. ...
... Ayrıca, Aslan ve ark. [4] yaptıkları çalışmada biyopsi tekniği ve hastalık lokalizasyonunun klinikopatolojik korelasyon üzerine bir etkisinin olmadığını göstermiştir. Bizim çalışmamızda ise yapılan tüm biyopsiler insizyonel teknikle yapıldığı için bu konuda bir kıyas yapma şansımız olmadı. ...
Article
Objective: The aim of this study was to evaluate the clinicopathologic correlation of skin biopsies in pediatric patients who consulted to Dicle University Medicine Faculty Hospital Department of Dermatology. Methods: 15337 patients under 16 years old who consulted to Dermatology polyclinic of Dicle University Hospital between January 2008- December 2013 were included in the study. The files of these patients were retrospectively reviewed and performed skin biopsies in 121 patients for diagnosis was detected. The data obtained from these 68 patients were evaluated. The obtained results were evaluated according to preliminary diagnosis and diagnosis correlation. Correlation was considered positive if there is an overlap between clinician’s preliminary diagnosis and diagnosis. Results: 39 patients (57.3%) were female and 29 patients (42.7%) were male. There was a correlation between preliminary diagnosis and pathological diagnosis in 57 patients (83.8%). First preliminary diagnosis and pathology correlation was positive in 42 (61.7%) patients, positive in 8 (11.7%) patients for second preliminary diagnosis and was positive in 4 (5.8%) patients for third diagnosis. Biopsy did not provide a contribution in 10 (14.7%) patients fordiagnosis. 1 (1.47%) patient had a diagnosis with outside of the preliminary diagnosis. Conclusion:Skin biopsy is a diagnostic technique, which is used to promote and strengthen the hands of clinicians in childhood as well as in adulthood patients particularly in patients with atypical clinical forms. However, it is seen that the way of using this diagnostic technique more efficiently is sharing better information by clinicians and if needed to support visual materials with the pathologist.
... Usually the clinical information provided to the pathologist is limited to the essential demographic data (age, gender, and body site of the lesion). However, there is growing evidence that providing clinical and dermoscopic images to the pathologist have the potential to improve his/her diagnostic confidence [1][2][3][4][5][6][7][8][9][10][11][12]. A number of previous studies have indeed demonstrated the benefit of integrating clinical with pathologic information, not only in the field of inflammatory skin disease but also in the context of skin tumors [2,3,6,7,9,10]. ...
... However, there is growing evidence that providing clinical and dermoscopic images to the pathologist have the potential to improve his/her diagnostic confidence [1][2][3][4][5][6][7][8][9][10][11][12]. A number of previous studies have indeed demonstrated the benefit of integrating clinical with pathologic information, not only in the field of inflammatory skin disease but also in the context of skin tumors [2,3,6,7,9,10]. However, all those studies were conducted retrospectively and no data are currently available about the role of a clinical-pathologic correlation approach on a daily basis in clinical practice. ...
Article
Full-text available
Several studies have demonstrated the benefit of integrating clinical with pathologic information, to obtain a confident diagnosis for melanocytic tumors. However, all those studies were conducted retrospectively and no data are currently available about the role of a clinical-pathologic correlation approach on a daily basis in clinical practice. In our study, we evaluated the impact of a routine clinical-pathologic correlation approach for difficult skin tumors seen over 3 years in a tertiary referral center. Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing. Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se. In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach.
... There have been studies that have compared prebiopsy clinical diagnoses with final histopathological diagnoses in neoplasms [6][7][8][9][10][11]. Sellheyer and Bergfeld [12] compared histopathological diagnosis with the clinical differentials in 4451 cases. ...
... The Dai et al. [13] study report only 2-12% of cases listed among second through fourth positions as the final histopathology diagnosis, and none of the fifth and sixth suggested diagnoses were correct. Also Aslan et al. [8] demonstrated that the first listed differential was more likely to be the final diagnosis (68.8%) than the second (22%). This confirms that dermatologists tend to list the diagnoses in the order of likelihood. ...
... Bu açıdan klinik bulguların histopatolojik olarak doğrulanması dermatologlar açısından önem taşımaktadır. Bununla birlikte doğru ve hızlı tanı için patolog ve klinisyen iş birliği ve iletişimi önemlidir (1,2). Pek çok dermatolojik hastalığın çakışan histopatolojik bulgularının olması nedeni ile dermatoloğun uygun klinik bilgiyi patoloğa vermesi gereklidir. ...
... Ekstremiteler çalışmamızda en sık biyopsi alınan lokalizasyondu. Literatürde iki farklı çalışmada da çalışma bulgumuzdan farklı olarak en sık biyopsi lokalizasyonu baş, boyun ve gövde olarak bildirilmiştir (1,8). Sadece papüloskuamöz hastalıklardaki klinik uyumu değerlendiren bir çalışmada ise bizim çalışmamız ile uyumlu olmak üzere en sık biyopsi lokalizasyonu ekstremiteler olarak bildirilmektedir (3). ...
Article
Full-text available
Objectives:Skin biopsy is a diagnostic tool that dermatologist often use in the differential diagnose. However depending on many factors sometimes it may be insufficient for definitive diagnosis. In this study it is aimed to evaluate retrospectively the clinicopathological compliance of skin biopsies from adult patients who applied to our dermatology outpatient clinic.Materials and Methods:Two hundred thirty three patients who have been performed skin biopsy and pathological examination over 18 years were included. The compliance between the pathology result and the each preliminary diagnose were evaluated. Statistical comparison was done in terms of age, gender, biopy site between groups with and without clinicopathological compliance.Results:Clinicopathological consistency ratio was determined as 89.7%. When dermatoses were classified clinicopathological consistency was detected with first prediagnose in 154 patient, with second prediagnose in 77 patients, with third prediagnose in 41 patients and with fourth prediagnosis in 11 patients. Consistency between pathological diagnosis and first, second, fourth prediagnose was revealed mostly in papülosquamous disease group and consistency between pathological diagnose and third prediagnose was revealed mostly in dermatitis group. No statistically meaningful difference was detected between gruops with and without clinicopathological consistency in terms of age, gender and biopsy type.Conclusion:In the light of our study findings, clinicopathological consistency seems to be high especially in papulosquamous diseases. We think that this compatibility can be improved in all dermatoses by using the skin biopsy method more effective with cooperation of clinician and pathologist.
... Çoğu dermatozun benzer histopatolojik bulgularının olması nedeniyle dermatoloğun uygun klinik bilgiyi patologla paylaşması gerekir. Uygun lezyondan ve bölgeden, uygun bir yöntemle biyopsi yapılması da doğru tanıya ulaşmada önemli olabilecek diğer faktörlerdir (4,5). ...
... Her üç çalışmadan sağlanan bu bulgular ön tanı sayısı artıkça korelasyon oranının azaldığını göstermektedir. Literatürde deri biyopsisi uygulanan farklı yaş grubu hastalarda klinikopatolojik korelasyon oranları %56,3-89,7 arasında farklılık göstermektedir (2)(3)(4)(5)(6)(9)(10)(11). Bu farklılık hasta sayısından, çalışmalardaki hastalık sınıflamalarının farklı olmasından, dermatoloji kliniklerinde görülen hastalıkların demografik ve bölgesel farklılıklar içermesinden ve deri biyopsisi uygulama alışkanlığının klinikler arasında değişiklik göstermesinden kaynaklanabilir. ...
Article
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Objectives:The incidences of dermatological diseases in the pediatric group differ from those in adults. Skin biopsies are frequently employed by dermatologists at differential diagnosis, and clinicopathological correlation is very important for definite diagnosis. The purpose of this study was to evaluate clinicopathological correlation in skin biopsies from child patients presenting to our dermatology clinic.Materials and Methods:Data of 116 patients aged 18 years or less who were subjected to skin biopsy and pathological examination were screened retrospectively. The results obtained were evaluated in terms of preliminary diagnosis and diagnosis correlation. The groups with and without clinicopathological correlation were subjected to statistical comparison in terms of age, sex, site of biopsy, type of biopsy, and number of preliminary diagnoses.Results:Sixty-three (54.3%) patients were boys and 53 (45.7%) were girls. The main dermatological diseases that were diagnosed were psoriasis, seborrheic dermatitis, Henoch-Schönlein purpura, urticaria, lichen planus, insect bite, pityriasis rubra pilaris, and morphea. Correlation between preliminary diagnoses and pathological diagnoses was present in 97 (83.6%) patients. Biopsy made no contribution to differential diagnosis in 11 (9.5%) patients, diagnoses other than preliminary diagnosis were made in six (5.2%) cases, and examination was not possible in two (1.7%) cases due to insufficient sample. No statistically significant difference was determined between the groups with and without clinicopathological correlation in terms of age, sex, site of biopsy, type of biopsy, or number of preliminary diagnoses (p>0.05).Conclusion:Similarly to dermatological diseases in adulthood, skin biopsy is an important diagnostic method that is also employed at differential diagnosis of dermatological diseases in childhood. We think that in order for this diagnostic method to be used more effectively, an accurate and detailed exchange of information is required between the clinician and pathologist, and that the two branches should evaluate the patient together.
... Previous studies have found that free-text information entered in pathology request forms is inaccurate. [6][7][8][9][10] Many dermatologists rely on assistants to complete their pathology request forms. These assistants may be unfamiliar with complex cutaneous anatomical nomenclature, which can contribute to imprecise biopsy-site descriptions in the pathology request form. ...
Article
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Dermatologists rely on skin biopsies to diagnose cutaneous tumors and rashes. Skin biopsy sites should be accurately identified with conventional anatomical site descriptors in the pathology request form. Reliance upon free-text entries to describe these biopsy sites is prone to user error and can cause medical misadventures such as wrong-site follow-up surgery. We sought to determine whether a smartphone application (RightSite) could improve the precision of biopsy site labeling. We conducted a prospective proof-of-concept study of 100 smartphone-assisted skin biopsy site identifiers with matched comparison to 100 historical controls. Student’s t-test was used to identify significant differences in the precision of anatomic descriptors before and after adoption of the application. We found a 69% improvement in precision of anatomic site labeling with the RightSite smartphone application (P < 0.0001). These data show smartphone-assisted biopsy site labeling improves the precision of anatomic site descriptors. Integrating graphical user interfaces into the electronic health records system could improve health care by standardizing anatomic site nomenclature and site-specific descriptors.
... Tanı konulan hastalıkların sıklığı değerlendirildiğinde bizim çalışmamızda; dermatitler ve allerjik ve hastalıklar grubu, inflamatuvar hastalıklar grubu, tümöral hastalıklar ve kollajen doku hastalıklarının ön sıralarda olduğu görülmektedir. Deri biyopsisi ile tanı konulan hastalık gruplarının sıklığı literatürde bazı farklılıklar göstermektedir (2,5,6). Bu durumun çalışmalardaki hastalık sınıflamalarının farklılık arz etmesi, dermatoloji kliniklerinde karşılaşılan hastaların demografik ve bölgesel farklılıklar içermesi ve deri biyopsisi alma alışkanlıklarının klinikten kliniğe değişmesine bağlı olduğunu düşünmekteyiz. ...
... This is in confirmation with this study. 15 In a study conducted in Indore by Sarang et al clinicohistopathological correlation was seen in 43.98% cases which is lesser as compared to this study. ...
Article
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Background: Clinical examination may suffice in making diagnosis of most dermatologic disorders but histopathological examination is often required to confirm the diagnosis and further categorize the lesions. Authors carried out this study to analyse the demographic and histomorphological characteristics of skin lesions, to determine the frequency of various dermatological disorders in the region and to evaluate the agreement between clinical and histopathological diagnosis.Methods: Punch biopsies of skin lesions received in histopathology section, were included in the study. Cases over a period of six months were analysed. Clinical details were recorded and histopathological analysis done. Special stains were applied wherever required.Results: Of the 120 cases studied, maximum cases fell in the category of 31-40 years, with male predominance. Authors observed wide variety of non-neoplastic and neoplastic lesions. Infectious diseases were the most common of all pathologies. Leprosy was the most common histopathological diagnosis. Complete clinicopathologic correlation was seen in 51.67% of cases while partial correlation was noted in 23.33% making a total of 75%. 25% histopathological diagnosis were inconsistent with the clinical diagnosis.Conclusions: Histopathology is a gold standard investigation and plays a very important role in confirmation of clinical diagnosis of various skin lesions. Punch biopsy is a relatively easy outpatient procedure to perform.
... In our study, although the ratio of correlation between the first three preliminary diagnoses and definitive diagnoses was 58.7%, it increased up to 79.1% with the successful clinicopathological correlation. Our findings were similar to the study done by Aslan et al, in which clinicopathological correlation was seen in 76.8% (10). In the study of Gupta et al, histopathological correlation with clinical diagnosis was seen in 85.8% of the cases. ...
... One of these studies measured the diagnostic yield of nondermatologists between 34% to 45% and that of dermatologists being 71% and 75% for inflammatory dermatoses or neoplasms and cysts, respectively [9]. Another study found 76.8% of pathological diagnoses to be consistent with the ones given by the dermatologists [10], whereas a third one measured a clinicopathological agreement of up to 92% with this success being attributed by the author to the close cooperation between the dermatologist and the pathologist [2]. In the present study, which was the largest of this kind to our knowledge, a 68% consistency of clinical and histological diagnoses was observed which is lesser than but in accord with the published data. ...
Article
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Background. Skin biopsy is an established method for allying the dermatologist in overcoming the diagnostic dilemmas which occur during consultations. However neither do all skin biopsies produce a conclusive diagnosis nor the dermatologists routinely perform this procedure to every patient they consult. The aim of this study was to investigate the favourable clinical diagnoses set by dermatologists when performing skin biopsy, the diagnoses reached by the dermatopathologists after microscopic examination, and the relationship between them and finally to comment on the instances that skin biopsy fails to fulfill the diagnostic task. Methods. Six thousand eight hundred and sixteen biopsy specimens were reviewed and descriptive statistics were performed. Results. The mean age of the patients was 54.58 ± 0.26 years, the most common site of biopsy was the head and neck (38.3%), the most frequently proposed clinical diagnoses included malignancies (19.28%), and the most prevalent pathological diagnosis was epitheliomas (21.9%). After microscopic examination, a specific histological diagnosis was proposed in 83.29% of the cases and a consensus between clinical and histological diagnoses was observed in 68% of them. Conclusions. Although there are cases that skin biopsy exhibits diagnostic inefficiency, it remains a valuable aid for the dermatology clinical practice.
... In a similar retrospective study on 403 patients the investigators had conducted 73% incisional biopsy, 7.7% excisional biopsy and 19.4% punch biopsies on skin. 11 they had performed incisional biopsy as in majority of cases like our study. Single or multiple di erential clinical diagnosis was found in 71.42% cases and the clinical description was found in rest of the (28.57%). ...
Article
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Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included for the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was recorded in data collection sheet. Histopathological diagnosis was correlated with clinical diagnosis to assess the consistency and it was the main outcome measure of present study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 77 years (5-82 years). Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In majority cases the collected specimen was skin (94.76%), the others type of specimen were mucous membrane (2.6%), nail matrix (1.9%) and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types (17.77%), lichen planus and its variants (14.12%), the connective tissue diseases (6.19%) and infectious diseases (5.39%). In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease (93.33%). The next common diagnosis was connective tissue diseases (79.48%), vasculitides (75%) and lichenoid diseases (73.56%).Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples.
... In a similar retrospective study on 403 patients the investigators had conducted 73% incisional biopsy, 7.7% excisional biopsy and 19.4% punch biopsies on skin. 11 they had performed incisional biopsy as in majority of cases like our study. Single or multiple di erential clinical diagnosis was found in 71.42% cases and the clinical description was found in rest of the (28.57%). ...
Article
Full-text available
Skin biopsy for histopathology is the most reliable investigation for diagnosis of skin diseases. The main purpose of skin biopsy is to confirm clinical diagnosis but dermatologists usually looking for the concordance with histopathological report. The aim of the study was to observe the consistency of clinical and histopathological diagnosis of skin diseases. An observational study was conducted on 630 patients that undertaken skin biopsy and that was performed at the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University from January 2018 to January 2019. Patients who were advised for biopsy by outpatient and inpatient department and the biopsy was done accordingly was included in the study. Finally the inclusion was confirmed when the histopathological report was available. Demographic information, clinical diagnosis, type of biopsy procedure, types of specimen taken and send for histopathological procedure and the histopathological diagnosis was noted in data collection sheet. Histopathological diagnosis and its correlation with clinical diagnosis was assessed for consistency and it was the main outcome measure of the study. The mean age of patients on whom biopsy was performed was 35.14 ±16.57 years and the age range was 5-82 years. Male patients outnumbered female and the male to female ratio was 1.15: 1. Three types of biopsy were performed among them incisional biopsy was the commonest type (93.5%). In most of the cases collected specimen was skin 94.76%, others type of specimens were mucous membrane 2.6%, nail matrix 1.9% and 0.6% specimen was hair follicle. Among the cases 71.43% was diagnosed clinically. The common clinical diagnosis in which biopsy was done was psoriasis and its types 17.77%, lichen planus and its variants 14.12%, the connective tissue diseases 6.19% and infectious diseases 5.39%. In 79.52% cases histopathological diagnosis was done and 68.22% diagnosis was consistent with the clinical diagnosis. The maximum clinico-pathological concordance was found in vesiculo-bullous disease 93.33%. Then connective tissue diseases 79.48%, vasculitides 75% and lichenoid diseases 73.56%. Skin biopsy is a conclusive tool to overcome diagnostic dilemmas in dermatological diseases. The clinico-pathological concordance is assumed lower than the expectation of dermatologists but the collective efforts of dermatologists and pathologists can improve the capacity of diagnosis of biopsy samples. Bangladesh Med J. 2020 Sept; 49(3) : 29-34
... the survey and in existing literature in both dermatology and radiology [4][5][6][7][8][9] include inadequate biopsy specimens, insufficient clinical information in the RFs/provider order entry forms and clinical visit notes, inadequate training of providers (dermatologists and nondermatologists) on how to provide appropriate clinical information, and limitations in existing computerized provider order entry systems in the EMRs. Communication failures in the SBCP may affect the quality and efficiency of dermatopathology diagnoses. ...
Article
The skin biopsy care process is prone to communication failures. We sought to solicit dermatopathologists about their opinions on the quality of clinical information provided in the requisition form (RF) that accompanies skin specimens and their suggestions on how to improve the process. A self-administered survey of the membership of the American Society of Dermatopathology was performed. Qualitative methods were used to analyze free-text comments. Of 1,102 participants, 153 completed the final question in the survey (response rate 14%). Respondent opinions fell into four critical themes: (1) quality of clinical information in the RF and adequacy of biopsy specimens, (2) training of residents and nondermatologist providers, (3) information transfer via electronic medical records, and (4) practice constraints. Dermatopathologists communicated that missing clinical information in the RF and inadequate specimens are common and adversely affect the quality of care. Multiple provider- and practice-related factors contribute to communication failures and deserve further investigation. Copyright© by the American Society for Clinical Pathology.
... Appearance of the skin diseases of the head and neck may have variations mimicking many other lesions resulting in difficulties of clinical diagnose. In this respect, examining the clinical findings dermoscopically, and histopathologic confirmation is important for an accurate and rapid diagnosis 1,2 . Dermoscopy is a non-invasive technique designed to assess the structures and color of the epidermis, dermoepidermal junction and the papillary dermis that cannot be seen with the naked eye 3 . ...
Article
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Objective: This study aimed at investigating the correlation between preliminary diagnosis and pathological diagnosis of head and neck lesions after dermoscopic examination and excisional biopsy. Methods: We included 89 patients with head and neck lesions admitted to dermatology outpatient clinic. The correlation between preliminary diagnoses and pathology results of head and neck lesions were evaluated. Results: Lesions in 22 of 89 patients (24.7%) were melanocytic and 67 of 89 patients (75.3%) were nonmelanocytic. The number of preliminary diagnosis of all patients was no more than three. The clinicopathological correlation rate was 78.65% (70 patients) for the first preliminary diagnosis, 34.83% (31 patients) for the second preliminary diagnosis and 7.86% (7 patients) for the third preliminary diagnosis. Initial preliminary diagnosis and pathological diagnosis were found different in 13 cases. In 3 cases, nodular lesions were excised considering skin malignancy clinically and dermoscopically, but the histopathological results were reported as benign lesions. Conclusion: We think that the cooperation of clinicians and pathologists can increase the exact pathological diagnosis rate and clinicopathological correlation.
... Epidemiologic studies have demonstrated a wide variability in prevalence rate of oral mucosal lesion (OML) in different populations. The development OML is influenced by external factors such as geographic region, socioeconomic status, and personal habits such as smoking, tooth-brushing habits, black tea and alcohol consumption [1, 2, 3, 4, 5, 6]. The prevalence of OML differs between regions as a result of these factors. ...
Article
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Background: Epidemiologic researches about oral mucosal lesions (OML) and possible relationships between OML and some habits or conditions have been performed in different populations. Objective: To determine the prevalence of oral mucosal lesions and relationship between OML and black tea, tooth brushing-habits, smoking, alcohol consumption, denture use on the oral mucosal lesions. Subjects and Methods: In this cross-sectional prospective clinical study, randomize selected 930 dermatology outpatients were examined using WHO criteria for oral mucosal lesions in our tertiary state hospital in Istanbul, Turkey, between September 2012 and December 2012. Results: Oral mucosal lesion was recorded in 500 (53.8%) subjects (164 (%32.8) female). The mean age of the patients was 41.3±1.99 years (ranging from 18 to 88). Frictional keratosis, nicotine stomatitis, and gingivitis were significantly more prevalent among the alcohol drinkers. Frictional keratosis was seen significantly higher in patients with denture. Heavy smoking was the risk factor for nicotine stomatitis, pigmentation, frictional keratosis, and gingivitis. Drinking black tea was found to be a significant risk factor for occurrence of nicotine stomatitis, xerostomia and gingivitis. Conclusion: This study has provided information about the epidemiologic aspect of oral mucosal lesion in this
Article
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p class="abstract"> Background: To ascertain the various cutaneous granulomatous disorders and clinicopathological concordance in skin biopsies. Methods: The study included the patients with skin biopsy showing granulomatous infiltrate in a tertiary care center. The cases were categorized according to level of concordance into consistent, corroborative and inconsistent based on the concurrence between clinical and histological diagnosis. Results: Of the total 155 granulomatous disorder, 75.48% showed clinicopathological concordance, 19.35% showed corroborative diagnosis while 5.16% were inconsistent. The maximum number of biopsies performed were in the group of young adult (19-49 years, 57.41%). The most common type of granuloma found was of tuberculoid type and disorders were Hansen’s disease, fungal infection and cutaneous tuberculosis. Conclusions: Our study showed that the coordination of dermatologist and pathologist plays a pivotal role in making accurate diagnosis of granulomatous cutaneous dermatoses.</p
Article
Conventional histopathology is the primary means of melanoma diagnosis. Both architectural and cytologic features aid in discrimination of melanocytic nevi from melanoma. Communication between the clinician and pathologist regarding the history, examination, differential diagnosis, prior biopsy findings, method of sampling, and specimen orientation is critical to an accurate diagnosis. A melanoma pathology report includes multiple prognostic indicators to guide surgical and medical management. In challenging cases, immunohistochemistry and molecular diagnostics may be of benefit.
Article
Background: The histopathologic diagnosis of MF is challenging, and there is significant overlap with benign inflammatory processes. Clinical features may be relevant in the assessment of skin biopsies. Methods: We provided photomicrographs to board‐certified dermatopathologists and one hematopathologist with and without accompanying clinical photographs and assessed accuracy and confidence in diagnosing MF. Results: We found that access to clinical photographs improved diagnostic accuracy in both MF and non‐MF (distractors); the degree of improvement was significantly higher in the non‐MF/distractor category. Across all categories, diagnostic confidence level was higher when clinical images were available. Conclusion: These findings suggest that clinical images are useful in making an accurate diagnosis of MF, and may be particularly helpful in ruling it out when an inflammatory disorder is clinically suspected. This article is protected by copyright. All rights reserved.
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Objective To determine the relative indications and clinicopathological consistency of skin biopsy. Methods 371 of 28466cases undergoing skin biopsy were reviewed and their histopathological reports evaluated for consistency with clinical diagnosis. Results 371 (1.3%) cases needed skin biopsy for diagnosis. Of these, 67.4% cases were consistent, 19.1% were corroborative and 13.5% were inconsistent with clinical diagnosis. Conclusion Providing proper history and clinical findings, provisional and differential diagnoses to pathologist increases the diagnostic yield of skin biopsy.
Article
Objectives: To define indices of completeness and accuracy of clinical information in the skin biopsy requisition form (RF) and correlate them with health care delivery outcomes and pathology service utilization. Methods: RFs in our pathology information system were reviewed and assessed for the presence of 10 clinical elements considered critical for dermatopathologic diagnosis. Accuracy was determined by reviewing corresponding clinical notes. Results: In total, 249 RFs were reviewed. In inflammatory dermatoses, provision of a clinical impression, provision of more than two elements, and achieving more than 75% accuracy were associated with improved outcomes and decreased utilization. For all nonlymphoproliferative cases, higher quality clinical information was associated with decreased turnaround time (P < .001). More clinical information was associated with increased utilization and turnaround time (P = .0235) for lymphoproliferative cases and higher resampling rates for melanocytic lesions (P = .0066). Conclusions: In inflammatory dermatoses, providing high-quality clinical information on the RF promotes optimal histopathologic diagnostic performance and appropriate pathology service utilization.
Article
: Clinical information is often critical to the histopathologic interpretation of cutaneous biopsies for inflammatory skin diseases. This information is often conveyed to the dermatopathologist as list of possible diagnoses. We reviewed 348 cases of biopsied inflammatory skin disease and measured the correlation between the original clinical differential diagnoses on the pathology requisition and the patient's final diagnosis. The final diagnosis was included among the suggested diagnoses in 270 of 348 (78%) cases reviewed. In 191 of 270 (71%) correctly diagnosed cases, the final diagnosis was listed first among those included in the differential diagnoses. The total number of suggested diagnoses did not correlate with overall diagnostic accuracy. The most commonly neglected diagnoses were eczematous dermatitis, psoriasis, lichen planus, and granuloma annulare. We conclude that the differential diagnosis submitted with pathology specimens for inflammatory skin disease includes the final diagnosis in a majority of cases. The first listed diagnosis has the highest positive predictive value. Submitting longer differential diagnosis lists did not improve diagnostic accuracy.
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Superficial inflammatory dermatoses are very common and comprise a wide, complex variety of clinical conditions. Accurate histological diagnosis, although it can sometimes be difficult to establish, is essential for clinical management. Knowledge of the microanatomy of the skin is important to recognise the variable histological patterns of inflammatory skin diseases. This article reviews the non-vesiculobullous/pustular inflammatory superficial dermatoses based on the compartmental microanatomy of the skin.
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Diagnostic accuracy for melanoma was determined in a dedicated pigmented lesion clinic. We assessed the impact of duration of experience in dermatology and also the relationship between tumour thickness and accuracy of clinical diagnosis. We reviewed the histopathology request forms and reports for all biopsies generated by the Pigmented Lesion Clinic, Western Infirmary, Glasgow during 1992-94 inclusive. The clinic is staffed by two consultants, one senior registrar and one registrar. Diagnostic accuracy, index of suspicion, sensitivity, specificity and positive predictive value were calculated for the clinic overall, and for each grade of staff. One hundred and sixty-three lesions were diagnosed clinically as melanoma. A histopathological diagnosis of melanoma was made for 128 lesions during this period, 113 of which had been correctly diagnosed before surgery. The diagnostic accuracy for two dermatologists each with 10 years experience in dermatology was 80%, with sensitivity of 91 % and positive predictive value of 86%. Diagnostic accuracy rates for two senior registrars (each with 3-5 years experience) and six registrars (each with 1-2 years experience) were 62% and 56%, respectively. Thin and intermediate thickness melanomas generated the greatest inaccuracy irrespective of clinical experience, although registrars failed to recognize melanoma three times more often than the other groups. We report the diagnostic accuracy for melanoma by trained dermatologists to be higher than previously reported. In comparison with trainees, < 10 years experience in dermatology and exposure to more than 10 melanomas per year appears to be associated with greater diagnostic accuracy. Knowledge of the current clinical diagnostic accuracy at varying levels of experience is essential if the impact of training is to be evaluated. As pigmented lesions of virtually all types can be treated within dermatology departments, dermatologists are the appropriate first point of referral for suspected early melanoma.
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Demand for surgical removal of presumed benign skin lesions is increasing. Our aim was to see whether the practice of sending every skin specimen for histological review is necessary in a hospital-based dermatology department. We first reviewed the histological findings of 1000 lesions removed between 1990 and 1992 where a firm clinical diagnosis of a benign melanocytic naevus (BM; n = 250), seborrhoeic keratosis (SK; n = 250), viral wart (VW; n = 250) or skin tag (n = 250) had been made. Next, we perused the original clinical diagnosis made for all histologically proven malignant melanomas (MM) between 1968 and 1993, to see whether they had been misdiagnosed as one of the above four common benign lesions. Histology confirmed the clinical diagnosis in 89% of presumed BM, 89% of presumed SK, 83% of presumed VW and 81% of presumed skin tags. Common causes of misdiagnosis were other benign lesions: 52% of incorrectly diagnosed BM were SK and 30% of incorrectly diagnosed SK were BM, while 38% of incorrectly diagnosed VW were SK. A total of seven malignant tumours (six basal cell carcinomas, one squamous cell carcinoma) were misdiagnosed clinically, one as BM, three as VW, and two as SK, but no malignant lesions were mistakenly diagnosed as skin tags. Review of 238 histologically proven malignant melanomas revealed a prior clinical diagnosis of BM in 9% and SK in 0.8%, but none were clinically misdiagnosed as skin tags or VW. Hence, in a hospital setting, a firm clinical diagnosis of a skin tag did not lead to missed malignancy, and routine histological confirmation of these lesions appears unnecessary. However, in the case of BM and SK, and where clinical doubt exists, histological review remains essential.
Article
Demand for surgical removal of presumed benign skin lesions is increasing. Our aim was to see whether the practice of sending every skin specimen for histological review is necessary in a hospital-based dermatology department. We first reviewed the histological findings of 1000 lesion removed between 1990 and 1992 where a firm clinical diagnosis of a benign melanocytic naevus (BM; n= 250). seborrhoeic keratosis (SK: n= 250). viral wan (VW; n=250) or skin tag (n= 250) had been made. Next, we perused the original clinical diagnosis made for all histologically proven malignant melanomas (MM) between 1968 and 1993, to see whether they had been misdiagnosed as one of the above four common benign lesions. Histology confirmed the clinical diagnosis in 89% of presumed BM. 89% of presumed SK, 83% of presumed VW and 81% of presumed skin tags. Common causes of misdiagnosis were other benign lesions: 52% of incorrectly diagnosed BM were SK and 30% of incorrectly diagnosed SK were BM, while 38% of incorrectly diagnosed VW were SK. A total of seven malignant tumours (six basal cell carcinomas, one squamous, cell carcinoma) were misdiagnosed clinically, one as BM, three as VW, and two as SK, but no malignant lesions were mistakenly diagnosed as skin lags. Review of 238 histologically proven malignant melanomas revealed a prior clinical diagnosis of BM in 9% and SK in 0.8%, but none were clinically misdiagnosed us skin tags or VW. Hence, in a hospital setting, a firm clinical diagnosis of u skin tag did not lead to missed malignancy, and routine histological confirmation of these lesions appears unnecessary. However, in the case of BM and SK. and where clinical doubt exists, histological review remains essential.
Article
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.
Article
The skin biopsy is considered one of the most important tools in dermatology. Two primary reasons a clinician may perform a skin biopsy are either to establish a diagnosis or to evaluate therapy. The objective of this study was to critically assess the value of the skin biopsy as a diagnostic test for inflammatory dermatoses. One hundred consecutive skin biopsy specimens where an inflammatory dermatosis was queried were reviewed. To assess the diagnostic ability of the skin biopsy, the frequency with which a correct diagnosis was made based on histopathological analysis alone was recorded, that is, an initial "blind" diagnosis made without clinical data. Once this was recorded, the clinical history was provided and a posthistory diagnosis reached. The posthistory diagnosis was then compared with the final working diagnosis in the patient case notes. In 55% of cases, histology was able to provide a prehistory specific diagnosis. In 31% of cases, histology was not able to provide a specific diagnosis but could provide a differential diagnosis. In two thirds of these (20 of the 31 cases), the diagnosis was reached posthistory with clinicopathologic correlation. In 12% of cases, histology could only provide a pattern analysis, and in 2% of cases, only a descriptive report could be issued. In 13% of cases, the biopsy provided the final working diagnosis, which had not been considered clinically. The skin biopsy for inflammatory dermatoses is clearly a worthwhile investigative procedure. Prehistory blind histology based on microscopic data provided an accurate diagnosis correlating to the working diagnosis in 53% of cases. The diagnostic boundaries of dermatopathology are such that in an additional 25 cases (25%) a diagnosis was reached with aid of clinical data proving the importance of providing a well-thought-out differential diagnosis. Overall, in 78% of cases, histology with the aid of clinical information was able to provide an accurate diagnosis correlating to the working diagnosis.
Article
In 1985 there were more than 40 million visits for ambulatory surgical procedures in the United States. Although benign cutaneous lesions are among the most frequent conditions to receive surgical treatment in ambulatory settings, their treatment is seldom subject to peer review. In this pilot study we assessed diagnostic accuracy and appropriateness of care using information available from the surgical pathology laboratory. We assessed these two measures of physician performance for 527 seborrheic keratoses removed by 133 clinicians affiliated with four different institutions. Overall, a correct preoperative diagnosis was provided in only 49% of cases. Dermatologists had the highest diagnostic accuracy (61% vs 35% for all other physicians). An appropriate procedure for the actual pathological diagnosis was performed in only 50% of cases. Lesions with a correct preoperative diagnosis were more than eight times more likely to receive appropriate care. Our data suggest that many clinicians fail to note a correct diagnosis of common cutaneous lesions before surgical removal, and many patients are treated with procedures that are more invasive than necessary for the final pathological diagnosis. Because the approach used in this pilot study relies on data already available, it has promise as a low-cost method of monitoring the quality of care of ambulatory surgery.
Article
To determine the ability of three doctors experienced in managing melanocytic lesions to diagnose correctly melanoma, dysplastic naevi, and various benign pigmented lesions. Independent clinical evaluation and histopathological assessment. Pigmented lesion clinic, which patients attend without an appointment for early diagnosis of melanoma. 86 Patients with lesions that were judged to be benign by at least one of the three doctors. The lesions were excised under local anaesthesia and sent for histopathological examination in coded bottles without clinical details. Comparison of clinical with histopathological diagnosis for each lesion. A total of 120 lesions were evaluated by at least two of the three doctors. The histopathological diagnoses were made by the same pathologist. The overall sensitivity (diagnostic accuracy) for the three doctors for all types of lesion was 50%. Of the 39 dysplastic naevi, only 19 were identified correctly by all observers, and a further 24 banal lesions were wrongly diagnosed as dysplastic by at least one doctor. Particular difficulty was experienced with small (less than 5 mm), flat lesions, which can be banal or potentially malignant. Critical diagnosis and management decisions concerning pigmented lesions should always be based on a combination of clinical and histopathological assessments and the history of the patient.
Article
The clinical diagnostic accuracy and index of suspicion of basal cell carcinoma were calculated. The data were compiled from dermatology residents, full-time dermatology university faculty, and dermatologists in private practice.
Article
To review three commonly performed skin biopsy procedures: shave, punch, and excision. English-language articles identified through a MEDLINE search (1966-1997) using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cross-references. Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care. Information was manually extracted from all selected articles and texts; emphasis was placed on information relevant to internal medicine physicians who want to learn skin biopsy techniques. Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions. Punch biopsies are simple to perform, have few complications, and if small, can heal without suturing. Closing the wound with unbraided nylon on a C-17 needle will enhance the cosmetic result but requires more expertise and time. Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, and can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources. Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thick skin or a P-3 needle on the face. All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis. Skin biopsies are an essential technique in the management of skin diseases and can enhance the dermatologic care rendered by internists.
Article
Diagnostic accuracy for melanoma was determined in a dedicated pigmented lesion clinic. We assessed the impact of duration of experience in dermatology and also the relationship between tumour thickness and accuracy of clinical diagnosis. We reviewed the histopathology request forms and reports for all biopsies generated by the Pigmented Lesion Clinic, Western Infirmary, Glasgow during 1992-94 inclusive. The clinic is staffed by two consultants, one senior registrar and one registrar. Diagnostic accuracy, index of suspicion, sensitivity, specificity and positive predictive value were calculated for the clinic overall, and for each grade of staff. One hundred and sixty-three lesions were diagnosed clinically as melanoma. A histopathological diagnosis of melanoma was made for 128 lesions during this period, 113 of which had been correctly diagnosed before surgery. The diagnostic accuracy for two dermatologists each with > 10 years experience in dermatology was 80%, with sensitivity of 91% and positive predictive value of 86%. Diagnostic accuracy rates for two senior registrars (each with 3-5 years experience) and six registrars (each with 1-2 years experience) were 62% and 56%, respectively. Thin and intermediate thickness melanomas generated the greatest inaccuracy irrespective of clinical experience, although registrars failed to recognize melanoma three times more often than the other groups. We report the diagnostic accuracy for melanoma by trained dermatologists to be higher than previously reported. In comparison with trainees, > 10 years experience in dermatology and exposure to more than 10 melanomas per year appears to be associated with greater diagnostic accuracy. Knowledge of the current clinical diagnostic accuracy at varying levels of experience is essential if the impact of training is to be evaluated. As pigmented lesions of virtually all types can be treated within dermatology departments, dermatologists are the appropriate first point of referral for suspected early melanoma.
Article
In the Irish health system, dermatology patients present to their family practitioner for diagnosis and treatment, and are referred to a dermatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably. To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer. Four hundred and ninety-three patients were seen by one of two dermatologists over a 1-year period at a rapid referral clinic for patients suspected by their family practitioners of having unstable or possibly malignant skin lesions; 213 of these patients had a diagnosis made on clinical examination by the dermatologist, while 264 had diagnostic or therapeutic biopsies performed; 16 patients defaulted on surgery. The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Thirty-eight patients had histologically proven skin malignancy. These were diagnosed accurately by the referring family practitioner in 22% of patients, while the dermatologists made the correct diagnosis prior to biopsy in 87%. In over 50% of cases diagnosed clinically, the dermatologist and family practitioner agreed. Histologically proven skin cancers were diagnosed accurately in only 22% of cases by family practitioners, compared to 87% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic keratoses, squamous cell carcinoma, and melanoma. Postgraduate education for family practitioners should be directed towards these areas of deficiency. Dermatologists had difficulty distinguishing pigmented actinic keratoses from melanoma.
Article
With the recent trend for nondermatologists to treat dermatologic disorders, this retrospective biopsy study reviews the accuracy of the clinical diagnosis of physicians of different specialties performing surgical dermatologic procedures. We assessed the diagnostic abilities of nondermatologist physicians who performed various types of skin biopsies and compared them with those of dermatologists. The clinical diagnoses of family physicians, plastic, general, and orthopedic surgeons, and internists and pediatricians versus dermatologists were correlated with the histopathologic diagnoses. In total, 4451 cases were analyzed. Dermatologists diagnosed twice the number of neoplastic and cystic skin lesions correctly (75%) than nondermatologists (40%). The clinical diagnosis rendered by family practitioners matched the histopathologic diagnosis in only 26% of neoplastic and cystic skin lesions. Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in the recognition of skin tumors than family physicians, but still had a diagnostic accuracy rate of only 45%. Inflammatory skin diseases were correctly diagnosed in 71% of the cases by dermatologists but in only 34% of the cases by nondermatologists. A limitation of this retrospective, unblinded study is the use of the clinical data from the pathology requisition form as a surrogate for clinical diagnostic accuracy. The overall accuracy of the clinical diagnosis depends heavily on the clinicopathologic correlation. Without sufficient clinical data, the histopathologic diagnosis will be limited or restricted. This review concludes that without basic dermatology knowledge, clinicopathologic correlation is compromised.
Article
General practitioners (GPs) are not encouraged to excise basal cell carcinomas (BCCs). Despite this, as many of 10% of BCCs may be excised by GPs. GPs may be able to have a greater role in the diagnosis and management of BCC, but much needs to be learnt before this can be advocated. To compare the practice of GPs, skin specialists (dermatologists and plastic surgeons) and other hospital specialists in excising BCCs. A retrospective analysis of all BCCs excised in the Grampian region between 1 January and 31 December 2005 was carried out In total, 1087 reports were rated for source, quality of clinical information provided and extent of excision. GPs perform significantly less well than skin specialists when diagnosing and excising BCCs, but appear equal in diagnostic skill and better at excision than other hospital specialists. Non-specialized GPs appear to perform as well as GPs with special interest (GPwSI) in adequately excising BCCs. In 18.7% of all cases, the information supplied to the pathologist with the biopsy sample was inadequate to draw a conclusion. GPs compare unfavourably with skin specialists in diagnosing and excising BCCs. The performance of nonspecialized GPs does not appear to differ markedly from that of GPwSI. There is considerable room to optimize current GP performance, particularly with lesions of the head and neck, and it may be that novel approaches to GP training are required to achieve this. Structured request forms may improve the quality of clinical information provided when skin biopsies are submitted for pathological examination.
Article
Skin cancer is an increasing problem in fair-skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately. To compare the clinical with the histological diagnosis of excised skin lesions from a set of epidemiological data. We analysed diagnostic accuracy stratified by histological subtype and body site and examined the histological nature of misclassified diagnosis. All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia from December 1996 to October 1999 were recorded. Positive predictive values (PPVs) and sensitivities were calculated for the clinical diagnoses and stratified by histological subtype and body site. Skin excisions in 8694 patients were examined. PPVs for the clinical diagnoses were: basal cell carcinoma (BCC) 72.7%; squamous cell carcinoma (SCC) 49.4%; cutaneous melanoma (CM) 33.3%. Sensitivities for the clinical diagnosis were: BCC 63.9%; SCC 41.1%; CM 33.8%. For BCC, PPVs and sensitivities were higher for the trunk, the shoulders and the face and lower for the extremities. The reverse pattern was seen for SCCs. Diagnostic accuracy was highest for BCC, the most prevalent lesion. Most excisions were correctly diagnosed or resulted in the removal of malignant lesions. With nonmelanocytic lesions, doctors tended to misclassify benign lesions as malignant, but were less likely to do the reverse. Although a small number of clinically diagnosed common naevi subsequently proved to be melanoma (6.3%), a higher proportion of all melanomas had been classified as common naevi (20.9%). Accuracy of diagnosis was dependent on body site.
Braun-Falco's dermatology
  • Burgdorf Whc
  • G Plewig
  • Wolff Hh
  • Landthaler
Burgdorf WHC, Plewig G, Wolff HH, Landthaler M, editors. Braun-Falco's dermatology. Italy: Springer Medizin Verlag; 2009.