Impact of Clinical Photographs on the Accuracy and Confidence in the Histopathologic Diagnosis of Mycosis Fungoides Journal of Cutaneous Pathology

TAKE-HOME MESSAGE

• This study utilized 50 cases of mycosis fungoides (MF) and 49 distractor cases (lichen planus, lichenoid drug, connective tissue disease, psoriasis, or spongiotic dermatitis), and 7 participants were given a survey in which each case was presented twice—once with only histologic images and once with both histologic and corresponding clinical images. Significantly more MF cases were diagnosed correctly when histology was combined with clinical images, and a similar trend was seen for distractor diagnoses.

• This study highlights the importance of clinical–pathologic correlation in diagnosing MF and underscores the utility of providing clinical photos to the pathologist both in diagnosis and exclusion of MF.

– Caroline K. Crabtree, MD

Abstract

BACKGROUND

The histopathologic diagnosis of MF is challenging, and there is significant overlap with benign inflammatory processes. Clinical features may be relevant in the assessment of skin biopsies.

METHODS

We provided photomicrographs to board-certified dermatopathologists and one hematopathologist with and without accompanying clinical photographs and assessed accuracy and confidence in diagnosing MF.

RESULTS

We found that access to clinical photographs improved diagnostic accuracy in both MF and non-MF (distractors); the degree of improvement was significantly higher in the non-MF/distractor category. Across all categories, diagnostic confidence level was higher when clinical images were available.

CONCLUSION

These findings suggest that clinical images are useful in making an accurate diagnosis of MF, and may be particularly helpful in ruling it out when an inflammatory disorder is clinically suspected. This article is protected by copyright. All rights reserved.

Journal of Cutaneous Pathology

Impact of Clinical Photographs on the Accuracy and Confidence in the Histopathologic Diagnosis of Mycosis Fungoides

J. Cutan. Pathol 2020 Dec 16;[EPub Ahead of Print], R Hadi, TI Miller, C May, JS Lehman, DD Bennett, M Piliang, O Chang, MM Shinohara