Decision-analytic model shows selective second-opinion strategy could increase diagnostic accuracy, decrease population-level costs<\/p>\n<\/h3>\n
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WEDNESDAY, June 9, 2021 (HealthDay News) — Second opinions may increase diagnostic accuracy and lower costs among patients undergoing skin biopsy for cutaneous melanocytic lesions, according to a study published online June 2 in JAMA Dermatology<\/em>.<\/p>\n Anna N.A. Tosteson, Sc.D., from the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire, and colleagues estimated the population impact of second-opinion strategies for the histopathologic diagnosis of cutaneous melanocytic lesions. The parameters for the decision-analytic model were based on diagnostic interpretations made by 187 pathologists, compared with reference panel diagnoses, for 240 cases.<\/p>\n The researchers found that without second opinions, 83.2 percent of diagnoses in the United States were estimated to be accurate (concor<\/u>dant with the reference diagnosis), with overinterpretation in 8.0 percent, underinterpretation in 8.8 percent of cases, and 16,850 misclassified diagnoses per 100,000 biopsies. With all second-opinion strategies, accuracy increased. When second opinions were universal, accuracy (87.4 percent concordance with 3.6 percent overinterpretation and 9.1 percent underinterpretation) and cost (an increase of more than $10 million per 100,000 biopsies per year) were highest versus no second opinions. Accuracy was highest with a selective second-opinion strategy based on pathologists’ desire or institutional requirements for a second opinion (86.5 percent concordance; 4.4 percent overinterpretation; 9.1 percent underinterpretation) and would reduce costs by more than $1.9 million per 100,000 skin biopsies versus no second opinions.<\/p>\n “We conclude that selective second-opinion strategies for interpretation of melanocytic skin lesions may be associated with improved diagnostic accuracy and decreased costs relative to no second opinions or universal second opinions,” the authors write.<\/p>\n Abstract\/Full Text (subscription or payment may be required)<\/a><\/p>\n <\/i><\/p>\n