Appropriate Use Criteria Guidelines Developed for Dermatopathology

Together with the American Academy of Dermatology and the College of American Pathologists, the American Society of Dermatopathology has developed guidelines for the appropriate use criteria (AUC) for 12 tests used in dermatopathology, covering 211 clinical scenarios. The guidelines were published in the Journal of the American Academy of Dermatology.

The investigators used RAND Corporation (Santa Monica, California)/University of California, Los Angeles (RAND/UCLA), appropriateness methodology, which combines evidence-based medicine, clinical experience, and expert judgment to create AUC in dermatopathology.

The 12 dermatopathology ancillary studies that underwent the AUC process included 3 topics in the lymphoproliferative group, 3 topics in the melanocytic group, 4 additional topics (human papillomavirus in situ hybridization, human papillomavirus immunohistochemistry, mismatch repair protein immunohistochemistry 4 antibody panel, and mismatch repair immunohistochemistry 2 antibody panel [screening for Muir-Torre syndrome]), and 2 soft tissue topics.

Ultimately, AUC were developed for 211 clinical scenarios. Consensus was achieved for 89% (188 of 211) of the clinical scenarios, with 44% (93 of 211) of these considered to be “usually appropriate,” 25% (52 of 211) deemed “rarely appropriate,” and 20% (43 of 211) deemed of “uncertain appropriateness.”

The investigators concluded that the methodology used in this analysis should focus on appropriateness, rather than involving a comparison between tests and regardless of cost. They believe that the ultimate decision regarding when to order specific tests should be the responsibility of the physician, with the anticipated benefits exceeding the negative consequences.

Bearing in mind that the recommendations outlined in this analysis may change with emerging evidence, the authors recommended that scenarios deemed of “uncertain appropriateness” be prioritized for further research.

Reference

Vidal CI, Armbrect EA, Andea AA, B, et al. Appropriate use criteria in dermatopathology: initial recommendations from the American Society of Dermatopathology [published online April 21, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.04.033