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Ambiguity
and Discordance

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Diagnostic Ambiguity and Discordance Have Been Extensively Documented in Multiple Publications

Diagnostic ambiguity and discordance have been extensively documented in multiple publications. However, many dermatopathologists and dermatologists feel that this problem may not impact them.

Diagnostic Ambiguity Can Lead to Clinical Management Uncertainty and Complex Conversations With Patients Regarding Treatment and Follow-Up

Elmore et al. 2017

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ambiguous
Haws et al. 2012

0%

ambiguous
Gerami et al. 2010

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ambiguous
Lodha et al. 2008

0%

ambiguous
Brochez et al. 2002

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ambiguous
Veenhuizen et al. 1997

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ambiguous

Ambiguity and Discordance Have an Impact on Clinical Decisions

Lesions are commonly sent for second opinions; however, the nature of many lesions remains ambiguous with discordant rates of diagnoses ranging from 57-75% (Elmore 2017; Piepkorn 2019).

Variable Discordance between outside pathology
and institutional reports (n=588)
Any variable 87%
Final diagnosis 1.8%
Breslow thickness 65.8%
Ulceration 5.1%
Regression 25.8%
Angiolymphatic invasion 2.89%
Perineural invasion 0.68%
Microsatellites 1.19%
Mitotic figures 56%

Patrawala et al.  2016

These changes led to a shift in AJCC staging of 20% of pathology reports which in turn would change the clinical management for that patient.

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