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An Interobserver Comparison Study

Scott R. Florell, MD; Kenneth M. Boucher, PhD; Sancy A. Leachman, MD, PhD; Farrukh Azmi, MD, PhD; Ronald M. Harris, MD, MBA; Janine C. Malone, MD; Guido Martignoni, MD; Glen M. Bowen, MD; John W. Gerwels, MD; Antoinette F. Hood, MD

Arch Dermatol. 2003;139:595-604.

Objectives  To assess interobserver and intraobserver concordance for identifying positive and negative margins in staged excisions of lentigo maligna and lentigo maligna melanoma and to determine if control biopsy specimens are useful to improve concordance.

Design  Retrospective, randomized interobserver and intraobserver comparison study of archived pathologic specimens. The study was conducted in 3 phases, and slides were evaluated blindly and independently by 5 pathologists: in phase 1, all slides were randomized and diagnosed as positive or negative. In phase 2, every third slide was evaluated again and diagnosed as positive or negative. In phase 3, slides were organized into cases, allowing evaluation of each margin in the context of the positive control (tumor from the center of the lesion) and negative control (control biopsy specimen), if available.

Setting  University referral center.

Study Material  A total of 301 glass microscopic slides from 27 patients who underwent staged excision for lentigo maligna or lentigo maligna melanoma from March 1997 to April 2001.

Main Outcome Measures  Interobserver and intraobserver concordance between original diagnoses and study diagnoses rendered on all slides by 5 pathologists.

Results  Phase 1 and 3 agreement was moderate ( range, 0.4-0.5). Phase 2 (intraobserver) agreement was moderate to good for all pathologists ( range, 0.6-0.9). Subset analysis revealed a statistically significant increase in agreement with the use of a control strip biopsy specimen for difficult slides.

Conclusions  Interobserver concordance for margin analysis in lentigo maligna and lentigo maligna melanoma is moderate, and intraobserver concordance is moderate to good. A control strip biopsy specimen may improve concordance in some cases.

From the Department of Dermatology (Drs Florell, Leachman, Harris, Bowen, and Gerwels) and the Huntsman Cancer Institute (Drs Boucher, Leachman, and Bowen), University of Utah Health Sciences Center, Salt Lake City; Department of Dermatology, Indiana University, Indianapolis (Drs Azmi, Malone, and Hood); and the Department of Pathology, University of Verona, Verona, Italy (Dr Martignoni). Dr Azmi is now with the Department of Pathology, Medical College of Virginia, Richmond. Dr Malone is now with the Department of Medicine, Division of Dermatology, and the Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Ky. The authors have no relevant financial interest in this article.

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