Population-Based Analysis of Histologically Confirmed Melanocytic Proliferations Using Natural Language Processing
Population-Based Analysis of Histologically Confirmed Melanocytic Proliferations Using Natural Language Processing
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DOI：
10.1001/jamadermatol.2017.4060
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发表时间：
2018-01-01
期刊：
影响因子：
10.9
通讯作者：
Elmore, Joann G.
中科院分区：
文献类型：
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作者：
Lott, Jason P.;Boudreau, Denise M.;Elmore, Joann G.
重要性：基于人群的与皮肤活检相关的组织学诊断分布信息尚不清楚。电子医疗记录（emr）能够自动提取病理报告数据，以提高我们对皮肤活检结果的流行病学理解，特别是那些黑色素细胞起源的结果。目的确定组织学证实的黑色素细胞病变在人群中的频率和分布。设计、环境和参与者：2007年1月1日至2012年12月31日，在美国太平洋西北地区的一个大型综合医疗保健系统中，对接受皮肤活检的成年患者的EMR病理报告进行了基于自然语言处理（NLP）的分析。皮肤活检程序。主要结果和测量主要结果是组织病理学诊断，使用基于nlp的系统处理EMR病理报告。我们确定诊断分类为黑素细胞病变和非黑素细胞病变的百分比。根据黑素细胞病理评估工具和诊断层次（mpah - dx）报告模式，将诊断分类为黑素细胞进一步分类为以下类别：I类（痣和其他良性增生，如轻度发育不良病变，通常不需要进一步治疗），II类（中度发育不良病变和其他低风险病变，可能需要狭窄的再切除= 1厘米的边缘和潜在的辅助治疗）。使用卫生系统癌症登记数据来定义MPATH-Dx IV级（T1a期）与V级（>= Tib期）侵袭性黑色素瘤病例的百分比。结果47 529例患者共行80 368例皮肤活检。近1 / 4的皮肤活检为黑素细胞病变（23%,n= 18 715），根据mpat - dx分类分布如下：1 83.1% (n= 15 558)；II类，8.3% (n = 1548)；111.4.5% (n = 842)；IV类：2.2% (n= 405)；V类为1.9% （n = 362）。结论和相关性：大约四分之一的皮肤活检诊断为黑素细胞增生。这些数据提供了第一个基于人群的黑素细胞病变谱，从良性到发育不良再到恶性。这些结果可以作为未来研究的基础，旨在了解黑素细胞增殖的流行病学和优化皮肤活检的利用。
IMPORTANCE Population-based information on the distribution of histologic diagnoses associated with skin biopsies is unknown. Electronic medical records (EMRs) enable automated extraction of pathology report data to improve our epidemiologic understanding of skin biopsy outcomes, specifically those of melanocytic origin.OBJECTIVE To determine population-based frequencies and distribution of histologically confirmed melanocytic lesions.DESIGN, SETTING, AND PARTICIPANTS A natural language processing(NLP)-based analysis of EMR pathology reports of adult patients who underwent skin biopsies at a large integrated health care delivery system in the US Pacific Northwest from January 1,2007, through December 31,2012.EXPOSURES Skin biopsy procedure.MAIN OUTCOMES AND MEASURES The primary outcome was histopathologic diagnosis, obtained using an NLP-based system to process EMR pathology reports. We determined the percentage of diagnoses classified as melanocytic vs nonmelanocytic lesions. Diagnoses classified as melanocytic were further subclassified using the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) reporting schema into the following categories: class I (nevi and other benign proliferations such as mildly dysplastic lesions typically requiring no further treatment), class II (moderately dysplastic and other low-risk lesions that may merit narrow reexcision with = 1-cm margins and potential adjunctive therapy). Health system cancer registry data were used to define the percentage of invasive melanomacases within MPATH-Dx class IV (stage T1a) vs V (>= stage Tib).RESULTS A total of 80 368 skin biopsies, performed on 47 529 patients, were examined. Nearly 1 in 4 skin biopsies were of melanocytic lesions (23%; n = 18 715), which were distributed according to MPATH-Dx categories as follows: class 1,83.1% (n= 15 558); class II, 8.3% (n = 1548); class 111.4.5% (n = 842); class IV. 2.2% (n= 405); and class V, 1.9% (n = 362).CONCLUSIONS AND RELEVANCE Approximately one-quarter of skin biopsies resulted in diagnoses of melanocytic proliferations. These data provide the first population-based estimates across the spectrum of melanocytic lesions ranging from benign through dysplastic to malignant. These results may serve as a foundation for future research seeking to understand the epidemiology of melanocytic proliferations and optimization of skin biopsy utilization.