The utility and challenges of histopathologic evaluation in the diagnosis of nonmalignant skin ulcers.
Histopathologic evaluation of cutaneous ulcers is indicated when the clinical diagnosis is unclear or when ulcers have not responded to standard of care. Many nonmalignant skin ulcers lack specific histologic findings on biopsy and pose a diagnostic challenge. While the usefulness of skin biopsies t...
| Publicado en: | Wound Repair & Regeneration Vol. 28; no. 2; pp. 219 - 224 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142101430&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 142101430 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10671927 DPV jtl: Wound Repair & Regeneration issn: 10671927 maglogo: Y pubinfo: dt: Mar2020 vid: 28 iid: 2 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 142101430 142101430 145826922 142101430 10.1111/wrr.12780 142101430 ppf: 219 ppct: 5 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: The utility and challenges of histopathologic evaluation in the diagnosis of nonmalignant skin ulcers. aug: au: Hammer, Phoebe Latour, Emile Bohnett, Mary C. McKenzie, Fatima Korcheva, Veselina B. Mengden, Stephanie White, Kevin P. Ortega‐Loayza, Alex G. affil: Oregon Health & Science University, Department of Dermatology, Portland Oregon,, USA sug: subj: Skin Ulcer Diagnosis Skin Ulcer Pathology Histology Human Retrospective Design Record Review Biopsy Comparative Studies Dermatologists Pathologists Attitude of Health Personnel Evaluation Descriptive Statistics Skin Ulcer Etiology Inflammation Complications Blood Vessels Physiopathology kappa Statistic Skin Physiopathology Skin Neoplasms Diagnosis Diagnosis, Laboratory Methods ab: Histopathologic evaluation of cutaneous ulcers is indicated when the clinical diagnosis is unclear or when ulcers have not responded to standard of care. Many nonmalignant skin ulcers lack specific histologic findings on biopsy and pose a diagnostic challenge. While the usefulness of skin biopsies to diagnose underlying malignancy in ulcerated lesions has been demonstrated in previous studies, their utility in the diagnosis of ulcers of other etiologies has not been reported. We conducted a retrospective study of 45 nonmalignant ulcer biopsies in a 3‐year period to compare the histologic diagnosis with the final diagnosis. Additionally, we assessed the diagnostic concordance among three blinded dermatopathologists when reviewing these cases. The leading histologic diagnosis from each of the three observers agreed with the final clinical diagnosis, on average, for 29.6% of the cases (average pairwise kappa = 0.15). Inflammatory ulcers had the lowest concordance between the observers and final diagnosis with an average of 26.0% of cases (average pairwise kappa = 0.06). The observers agreed with each other for 35.6% of the cases (Fleiss' kappa = 0.32). The highest agreement among observers was in the vascular/vasculopathic category (50%, Fleiss' kappa = 0.44). Our results indicate that skin biopsies alone are useful in the evaluation of nonmalignant ulcers to rule out other conditions (e.g. neoplasm) but frequently not sufficient to establish a definitive diagnosis. Additional clinicopathologic correlation is necessary in the final assessment of nonmalignant ulcers to determine the diagnosis. Future research endeavors should explore alternative approaches to more efficiently diagnose nonmalignant skin ulcers. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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