Publications by authors named "Lisa Reisch"
Article Synopsis
- Deep learning enhances computer-aided diagnosis systems by utilizing pathologists' viewing patterns through generated heatmaps, guiding training without needing individual case annotations.
- The proposed model, a U-Net with a pre-trained ResNet-18 encoder, significantly outperforms traditional methods in detecting areas of interest in melanoma diagnosis, achieving higher precision, recall, F1-score, and Intersection over Union.
- Clinical evaluations by dermatopathologists confirm the model's effectiveness in mimicking diagnostic behavior and accurately pinpointing critical regions, demonstrating that heatmaps can improve diagnostic accuracy, streamline annotations, and support training for new pathologists.
Article Synopsis
- The incidence of melanoma cases has been rising, and studies show significant disagreement among pathologists when diagnosing intermediate melanocytic lesions.
- Researchers aimed to explore which pathologist characteristics influence their likelihood of diagnosing these lesions as higher or lower grade and identifying invasive melanoma.
- Data was analyzed from two national studies involving 338 pathologists, looking at various factors like demographics, experience, and specialty training, to understand how these characteristics affect diagnostic tendencies.
Background: A standardized pathology management tool for melanocytic skin lesions may improve patient care by simplifying interpretation and categorization of the diverse terminology currently extant.
Objective: To assess an online educational intervention that teaches dermatopathologists to use the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx), a schema collapsing multiple diagnostic terms into 5 classes ranging from benign to invasive melanoma.
Methods: Practicing dermatopathologists ( 149) from 40 US states participated in a 2-year educational intervention study (71% response rate).
VSGD-Net: Virtual Staining Guided Melanocyte Detection on Histopathological Images.
IEEE Winter Conf Appl Comput Vis
January 2023
Detection of melanocytes serves as a critical prerequisite in assessing melanocytic growth patterns when diagnosing melanoma and its precursor lesions on skin biopsy specimens. However, this detection is challenging due to the visual similarity of melanocytes to other cells in routine Hematoxylin and Eosin (H&E) stained images, leading to the failure of current nuclei detection methods. Stains such as Sox10 can mark melanocytes, but they require an additional step and expense and thus are not regularly used in clinical practice.
View Article and Find Full Text PDFDiagnostic error can be defined as deviation from a gold standard diagnosis, typically defined in terms of expert opinion, although sometimes in terms of unexpected events that might occur in follow-up (such as progression and death from disease). Although diagnostic error does exist for melanoma, deviations from gold standard diagnosis, certainly among appropriately trained and experienced practitioners, are likely to be the result of uncertainty and lack of specific criteria, and differences of opinion, rather than lack of diagnostic skills. In this review, the concept of diagnostic error will be considered in relation to diagnostic uncertainty, and the concept of overdiagnosis in melanoma will be presented and discussed.
View Article and Find Full Text PDFImportance: A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose.
Objective: To revise the MPATH-Dx version 1.
Although pathologists have their own viewing habits while diagnosing, viewing behaviors leading to the most accurate diagnoses are under-investigated. Digital whole slide imaging has enabled investigators to analyze pathologists' visual interpretation of histopathological features using mouse and viewport tracking techniques. In this study, we provide definitions for basic viewing behavior variables and investigate the association of pathologists' characteristics and viewing behaviors, and how they relate to diagnostic accuracy when interpreting whole slide images.
View Article and Find Full Text PDFImportance: Medical second opinions are common, although little is known about the best processes for obtaining them. This study assesses whether knowledge of a prior physician's diagnosis influences consulting physicians' diagnoses.
Objective: To measure the extent to which dermatopathologists' diagnoses are influenced by prior diagnostic information from another dermatopathologist.
Importance: Despite evidence of overdiagnosis of in situ and invasive melanoma, neither the perceptions of practicing dermatopathologists about overdiagnosis nor possible associations between perceptions of overdiagnosis and diagnostic practices have been studied.
Objective: To examine practicing US dermatopathologists' perceptions of melanoma overdiagnosis as a public health issue, and to associate diagnostic behaviors of dermatopathologists with perceptions of melanoma overdiagnosis.
Design, Setting, And Participants: This survey study included 115 board-certified and/or fellowship-trained dermatopathologists and their diagnostic interpretations on a set of 18 skin biopsy cases (5 slide sets comprising 90 melanocytic skin lesions).
Background: Previous studies of second opinions in the diagnosis of melanocytic skin lesions have examined blinded second opinions, which do not reflect usual clinical practice. The current study, conducted in the USA, investigated both blinded and nonblinded second opinions for their impact on diagnostic accuracy.
Methods: In total, 100 melanocytic skin biopsy cases, ranging from benign to invasive melanoma, were interpreted by 74 dermatopathologists.
Background: Care partners are key members of patients' health care teams, yet little is known about their experiences accessing patient information via electronic portals.
Objective: To better understand the characteristics and perceptions of care partners who read patients' electronic visit notes.
Patient Involvement: Focus groups with diverse patients from a community health center provided input into survey development.
Background: Synoptic reporting is recommended by many guideline committees to encourage the thorough histologic documentation necessary for optimal management of patients with melanoma.
Methods: One hundred fifty-one pathologists from 40 US states interpreted 41 invasive melanoma cases. For each synoptic reporting factor, the authors identified cases with "complete agreement" (all participants recorded the same value) versus any disagreement.
Background: Diagnostic terms used in histopathology reports of cutaneous melanocytic lesions are not standardized. We describe dermatopathologists' views regarding diverse diagnostic terminology and the utility of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) for categorizing melanocytic lesions.
Methods: July 2018-2019 survey of board-certified and/or fellowship-trained dermatopathologists with experience interpreting melanocytic lesions.
Objectives: "Assurance behaviors," a type of defensive medicine, involve physicians' utilization of additional patient services to avoid adverse legal outcomes. We aim to compare the use of clinical behaviors (such as ordering additional tests, services, and consultations) due to malpractice concerns with the same behaviors due to patient safety concerns.
Methods: A national sample of dermatopathologists (n = 160) completed an online survey.
Background: Melanocytic tumors are often challenging and constitute almost one in four skin biopsies. Immunohistochemical (IHC) studies may assist diagnosis; however, indications for their use are not standardized.
Methods: A test set of 240 skin biopsies of melanocytic tumors was examined by 187 pathologists from 10 US states, interpreting 48 cases in Phase I and either 36 or 48 cases in Phase II.
Importance: Many patients presently have access to their pathologic test result reports via online patient portals, yet little is known about pathologists' perspective on this topic.
Objective: To examine dermatopathologists' experience and perceptions of patient online access to pathology reports.
Design, Setting, And Participants: A survey of 160 dermatopathologists currently practicing in the United States who are board certified and/or fellowship trained in dermatopathology was conducted between July 15, 2018, and September 23, 2019.
Background: Although treatment guidelines exist for melanoma in situ and invasive melanoma, guidelines for other melanocytic skin lesions do not exist.
Objective: To examine pathologists' treatment suggestions for a broad spectrum of melanocytic skin lesions and compare them with existing guidelines.
Methods: Pathologists (N = 187) completed a survey and then provided diagnoses and treatment suggestions for 240 melanocytic skin lesions.
Objective: To gain understanding of breast cancer care providers' attitudes regarding communicating with patients about diagnostic errors, to inform interventions to improve patient- provider discussions.
Methods: Focus groups were held in three U.S.
Importance: Histopathologic criteria have limited diagnostic reliability for a range of cutaneous melanocytic lesions.
Objective: To evaluate the association of second-opinion strategies by general pathologists and dermatopathologists with the overall reliability of diagnosis of difficult melanocytic lesions.
Design, Setting, And Participants: This diagnostic study used samples from the Melanoma Pathology Study, which comprises 240 melanocytic lesion samples selected from a dermatopathology laboratory in Bellevue, Washington, and represents the full spectrum of lesions from common nevi to invasive melanoma.
Importance: The recently updated American Joint Committee on Cancer (AJCC) classification of cancer staging, the , 8th edition (), includes revisions to definitions of T1a vs T1b or greater. The Melanoma Pathology Study database affords a comparison,of pathologists' concordance and reproducibility in the microstaging of melanoma according to both the existing 7th edition ) and the new .
Objective: To compare and to examine whether changes to the definitions of T1a and T1b or greater are associated with changes in concordance and reproducibility.
Diagnostic discrepancy among pathologists interpreting melanocytic skin lesions (MSL) is an ongoing concern for patient care. Given that job satisfaction could impact patient care, this study aimed to characterize which pathologists enjoy interpreting MSL and estimate the association between enjoyment and diagnostic accuracy. Pathologists' demographics, training, and experience were obtained by a cross-sectional survey.
View Article and Find Full Text PDFImportance: Use of digital whole-slide imaging (WSI) for dermatopathology in general has been noted to be similar to traditional microscopy (TM); however, concern has been noted that WSI is inferior for interpretation of melanocytic lesions. Since approximately 1 of every 4 skin biopsies is of a melanocytic lesion, the use of WSI requires verification before use in clinical practice.
Objective: To compare pathologists' accuracy and reproducibility in diagnosing melanocytic lesions using Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) categories when analyzing by TM vs WSI.
Objectives: The impact of malpractice concerns on pathologists' use of defensive medicine and interpretations of melanocytic skin lesions (MSLs) is unknown.
Methods: A total of 207 pathologists interpreting MSLs responded to a survey about past involvement in malpractice litigation, influence of malpractice concerns on diagnosis, and use of assurance behaviors (defensive medicine) to alleviate malpractice concerns. Assurance behaviors included requesting second opinions, additional slides, additional sampling, and ordering specialized tests.
Background: Melanoma staging has depended on depth of invasion (Breslow thickness, BT), mitotic rate (MR) and ulceration. In anticipation of the AJCC's eighth edition, variability in pathologists' assessment of these factors and consequently in tumor staging was assessed.
Methods: One-hundred and fifteen cases of invasive melanoma, established by a consensus panel, were assessed by 187 pathologists.
Background: Little is known about how pathologists process differences between actual and perceived interpretations.
Objective: To compare perceived and actual diagnostic agreement before and after educational interventions.
Methods: Pathologists interpreted test sets of skin and/or breast specimens that included benign, atypical, in situ and invasive lesions.