Melanocytic Histopathology Reading Study: Exploring the impact of clinical information and MPATH-Dx V2.0 on pathologists’ diagnoses of melanocytic skin lesions
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Open Access
Type
ThesisThesis type
Masters by ResearchAuthor/s
Lai, BelindaAbstract
The clinical reference standard for diagnosis of primary cutaneous melanoma is the histopathology examination of a tissue biopsy specimen. However, there is evidence of poor accuracy and reproducibility for histopathology diagnosis of these lesions. Additionally, the “Melanocytic ...
See moreThe clinical reference standard for diagnosis of primary cutaneous melanoma is the histopathology examination of a tissue biopsy specimen. However, there is evidence of poor accuracy and reproducibility for histopathology diagnosis of these lesions. Additionally, the “Melanocytic Histopathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx V1.0)” classification schema was recently revised to also address the poor agreement amongst pathologists across the spectrum of atypical naevi and early melanoma, with MPATH-Dx V2.0 now in use. Thus, there are three objectives for this thesis: 1. To synthesise all available evidence on the impact of providing clinical information to pathologists assessing melanocytic skin lesions; 2. To determine the effects of providing clinical and dermoscopy images with a dermoscopy report on pathologists’ diagnoses of melanocytic skin lesions; and 3. To explore the impact of MPATH-Dx V2.0 compared to V1.0 on diagnostic agreement in the histopathologic assessment of melanocytic skin lesions. To address the first objective, a scoping review was performed to examine the impact of clinical information on the histopathology diagnosis of melanocytic skin lesions. To address the second and third objectives, a prospective pathology reading study assessed the effects of providing clinical images and dermoscopy reports to dermatopathologists. This thesis found that although clinical information can help with improving the diagnostic confidence and interobserver agreement and may reduce the odds of missing a progressive melanoma, dermoscopy reports and dermoscopy images may have limited impact on improving histopathology diagnosis. Further, the appropriateness of a tendency for histopathology upgrading with dermoscopy images and report is unknown. The MPATH-Dx V2.0 classification schema may beneficially improve pathologists’ agreement on lesions and direct management intensity to the risk of future adverse outcomes.
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See moreThe clinical reference standard for diagnosis of primary cutaneous melanoma is the histopathology examination of a tissue biopsy specimen. However, there is evidence of poor accuracy and reproducibility for histopathology diagnosis of these lesions. Additionally, the “Melanocytic Histopathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx V1.0)” classification schema was recently revised to also address the poor agreement amongst pathologists across the spectrum of atypical naevi and early melanoma, with MPATH-Dx V2.0 now in use. Thus, there are three objectives for this thesis: 1. To synthesise all available evidence on the impact of providing clinical information to pathologists assessing melanocytic skin lesions; 2. To determine the effects of providing clinical and dermoscopy images with a dermoscopy report on pathologists’ diagnoses of melanocytic skin lesions; and 3. To explore the impact of MPATH-Dx V2.0 compared to V1.0 on diagnostic agreement in the histopathologic assessment of melanocytic skin lesions. To address the first objective, a scoping review was performed to examine the impact of clinical information on the histopathology diagnosis of melanocytic skin lesions. To address the second and third objectives, a prospective pathology reading study assessed the effects of providing clinical images and dermoscopy reports to dermatopathologists. This thesis found that although clinical information can help with improving the diagnostic confidence and interobserver agreement and may reduce the odds of missing a progressive melanoma, dermoscopy reports and dermoscopy images may have limited impact on improving histopathology diagnosis. Further, the appropriateness of a tendency for histopathology upgrading with dermoscopy images and report is unknown. The MPATH-Dx V2.0 classification schema may beneficially improve pathologists’ agreement on lesions and direct management intensity to the risk of future adverse outcomes.
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Date
2025Rights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, The University of Sydney School of Public HealthAwarding institution
The University of SydneyShare