#dermpathJC September 2018:
Thursday, September 27th, 9pm EST
Article discussed: Appropriate use criteria in dermatopathology: Initial recommendations from the American Society of Dermatopathology
Authors: Claudia I. Vidal, Eric A. Armbrect, Aleodor A. Andea, Angela K. Bohlke, Nneka I. Comfere, Sarah R. Hughes, Jinah Kim, Jessica A. Kozel, Jason B. Lee, Konstantinos Linos, Brandon R. Litzner, Tricia A. Missall, Roberto A. Novoa, Uma Sundram, Brian L. Swick, Maria Yadira Hurley, Murad Alam, Zsolt Argenyi, Lyn M. Duncan, Dirk M. Elston, Patrick O. Emanuel, Tammie Ferringer, Maxwell A. Fung, Gregory A. Hosler, Alexander J. Lazar, Lori Lowe, Jose A. Plaza, Victor G. Prieto, June K. Robinson, Andras Schaffer, Antonio Subtil, Wei‐Lien Wang
Temporary open access available at https://doi.org/10.1111/cup.13142
Summary author: Patrick Rush, DO (@DrPatrickRush)
Journal Club Summary:
The month’s journal club article reviewed the recently published work by the American Society of Dermatopathology on appropriate use. This article is the first of what seems like will be several works from the American Society of Dermatopathology (ASDP) with input from the American Academy of Dermatology (AAD) and the College of American Pathologists (CAP) on appropriate use criteria as it applies to the field of Dermatopathology; specifically the group addressed 211 clinical scenarios and 12 ancillary studies. This publication outlined the appropriateness (without comparison between tests or consideration of costs) of 12 ancillary tests.
The journal club was once again maintained a lively discussion with a good number of participants from all over, with over 30 participants tweeting over 200 times and leaving 762.563K impressions over the following week.
All together the active participants seemed to agree with the sentiments of a comment made by @MightyDermPath that the work was not very controversial, but that it was an important start.
It was a common comment that the article was very table heavy that made for some dense reading. However, the upside being it was very easy to go back and read through their thought process.
The AUC took the above systematic approach to stratifying their recommendations are rarely appropriate, uncertain, and usually appropriate. Raters were also allowed use an “OUT” options if they felt that consultation with the clinician was necessary to determine the appropriateness, and this occurred in only 9 clinical scenarios where >3 panel raters used the OUT option. Altogether they rated 211 clinical scenarios and a consensus was reached for 188 (89%) of them. The major issues to be addressed were separated into general groups: Lymphoproliferative, melanocytic, soft tissue, Muir-Torre syndrome mismatch repair IHC, Other (HPV, ISH, IHC).
B and T cell receptor rearrangement studies were addressed in this group.
The use of FISH, CGH and qRT-PCR were addressed in this group.
Soft tissue group:
FISH testing for EWSR1 for clear cell sarcoma and t(17;22) in DFSP were discussed in this group.
Muir-Torre syndrome mismatch repair IHC:
The use of an IHC antibody panel for screening of Muir-Torre syndrome (a subset of Lynch) were discussed in this group.
Other (HPV, ISH, IHC):
The use of IHC or ISH in the evaluation of HPV association of different squamous lesions was evaluated in this group.
While the article was certainly very chart heavy, it is probably the best way to present the data that the working group found, as they were very thorough in addressing a number of clinical scenarios for each ancillary modality that they addressed. This seems to be not only a very thorough way to address these topics but a very usable way to present the information to those in practice who will be looking for an “at a glance” way to determine test appropriateness.
@JRamirezMD said that the suggestions published were not very different from the way that he currently practices, and others seemed to echo his statements about their own practice habits.
The authors say, and the participants of September 2018 #dermpathJC seemed to agree, this is a good place to start, but that these sorts of guidance works will need to evaluated periodically as technology changes and with the more evidence based support the better. Types of works like these are important for political reasons as well as self policing is an important part of appropriate medical practice in this day and age.
Until next month, #dermpathJC signing off.