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Reproducibility of AJCC Staging Parameters in Primary Cutaneous Melanoma: An Analysis of 4,924 Cases

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pathology reports are of critical importance for conveying information to clinicians who must make important management decisions for their patients. This study sought to assess and compare the precision, reproducibility, and completeness of external pathology reports and pathology reports generated by central review of each case in a large cohort of primary cutaneous melanoma patients.

Methods

Details of matched external pathology reports and corresponding review reports for 4,924 primary cutaneous invasive melanomas diagnosed and treated at Melanoma Institute Australia (MIA) between 2001 and 2011 were analyzed.

Results

Interobserver agreement was excellent for American Joint Committee on Cancer (AJCC) T staging parameters: Breslow thickness (intraclass correlation coefficient [ICC] 0.984), mitotic rate (ICC 0.833), and ulceration (kappa statistic [κ] 0.823). All three of these important pathologic variables were included in 92.4 and 66.9 % of review (MIA) and external (non-MIA) pathology reports, respectively. Completeness of MIA and non-MIA pathology reports for the three essential T-staging criteria increased significantly from 87.9 to 94.6 % (χ 2 = 9.1, df = 1, P = 0.003) and from 53.2 to 74.3 % (χ 2 = 35.0, df = 1, P < 0.001) over the 10-year study period. The AJCC N staging parameter of microsatellites was recorded in only 43 % of non-MIA reports and demonstrated moderate concordance (κ = 0.560).

Conclusions

Reproducibility and completeness of pathology reports for many important histopathologic features have improved in recent years. Nevertheless, the documentation of microsatellites remained poor in external pathology reports. To enhance the usefulness of the pathology report for the provision of optimal melanoma patient care, continued efforts to encourage pathologists to document its key features appear warranted.

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Acknowledgment

Support in part by the Australian National Health and Medical Research Council and Cancer Institute New South Wales. RAS is supported by the Cancer Institute New South Wales Fellowship program. Assistance from colleagues at Melanoma Institute Australia and Royal Prince Alfred Hospital is also gratefully acknowledged.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Melanoma Institute Australia, North Sydney, NSW, Australia

    Maarten G. Niebling MD, Lauren E. Haydu BSCHE, MIPH, Rooshdiya Z. Karim MBBS, PhD, FRCPA, John F. Thompson MD, FRACS, FACS & Richard A. Scolyer MD, FRCPA, FRCPath

  2. Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Lauren E. Haydu BSCHE, MIPH & John F. Thompson MD, FRACS, FACS

  3. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia

    Rooshdiya Z. Karim MBBS, PhD, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  4. Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Rooshdiya Z. Karim MBBS, PhD, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  5. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia

    John F. Thompson MD, FRACS, FACS

Authors
  1. Maarten G. Niebling MD
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  2. Lauren E. Haydu BSCHE, MIPH
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  3. Rooshdiya Z. Karim MBBS, PhD, FRCPA
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  4. John F. Thompson MD, FRACS, FACS
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  5. Richard A. Scolyer MD, FRCPA, FRCPath
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Corresponding author

Correspondence to John F. Thompson MD, FRACS, FACS.

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Supplementary Fig. 3

Scatterplot demonstrating interobserver agreement of all valid cases (n = 4785) for Breslow thickness (mm) (TIFF 2353 kb)

Supplementary material 2 (DOCX 16 kb)

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Niebling, M.G., Haydu, L.E., Karim, R.Z. et al. Reproducibility of AJCC Staging Parameters in Primary Cutaneous Melanoma: An Analysis of 4,924 Cases. Ann Surg Oncol 20, 3969–3975 (2013). https://doi.org/10.1245/s10434-013-3092-5

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  • DOI: https://doi.org/10.1245/s10434-013-3092-5

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