Prior knowledge of the clinical picture does not introduce bias in the histopathologic diagnosis of melanocytic skin lesions

Ferrara, Gerardo; Annessi, Giorgio; Argenyi, Zsolt; Argenziano, Giuseppe; Beltraminelli, Helmut; Cerio, Rino; Cerroni, Lorenzo; Cota, Carlo; Simonetti, Stefano; Stefanato, Catherine M; Zalaudek, Iris; Kittler, Harald; Soyer, H Peter (2015). Prior knowledge of the clinical picture does not introduce bias in the histopathologic diagnosis of melanocytic skin lesions. Journal of cutaneous pathology, 42(12), pp. 953-958. Wiley-Blackwell 10.1111/cup.12589

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A common debate among dermatopathologists is that prior knowledge of the clinical picture of melanocytic skin neoplasms may introduce a potential bias in the histopathologic examination. Histologic slides from 99 melanocytic skin neoplasms were circulated among 10 clinical dermatologists, all of them formally trained and board-certified dermatopathologists: 5 dermatopathologists had clinical images available after a 'blind' examination (Group 1); the other 5 had clinical images available before microscopic examination (Group 2). Data from the two groups were compared regarding 'consensus' (a diagnosis in agreement by ≥4 dermatopathologists/group), chance-corrected interobserver agreement (Fleiss' k) and level of diagnostic confidence (LDC: a 1-5 arbitrary scale indicating 'increasing reliability' of any given diagnosis). Compared with Group 1 dermatopathologists, Group 2 achieved a lower number of consensus (84 vs. 90) but a higher k value (0.74 vs. 0.69) and a greater mean LDC value (4.57 vs. 4.32). The same consensus was achieved by the two groups in 81/99 cases. Spitzoid neoplasms were most frequently controversial for both groups. The histopathologic interpretation of melanocytic neoplasms seems to be not biased by the knowledge of the clinical picture before histopathologic examination.

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