Discrepancies Inspire Study
Elmore's personal diagnostic odyssey ends well. Instead of melanoma, she had an atypical Spitz lesion that can mimic melanoma.
Ten years out, she is happy and healthy. But her experience—and the emotions that went along with it—inspired her to study the diagnostic process with an eye to improving it.
In addition to practicing as a physician, Elmore conducts scientific research. Prior to her skin biopsy, Elmore had researched the variability in how radiologists interpret mammograms.
But her personal experience as a patient inspired her to expand her research from radiology into pathology. She wanted a better understanding of the variability of results there.
"I decided I wanted to study this," says Elmore. "Given my own experience, I wanted to see how we could improve things. So we decided to turn the microscope back on ourselves to see how we are doing."
Study Examines Accuracy
Elmore's study of the variability in melanoma diagnostic findings was published in the British Medical Journal. The study began with 240 skin biopsy slides ranging from a normal mole to invasive melanoma.
Each of the skin biopsy slides was first interpreted by a panel of experts independently. Then the experts got together to reach a consensus. For the purposes of the study, the consensus among the experts was considered the gold standard diagnosis for each slide.
Elmore's research team then divided the biopsy slides into smaller sets and shipped them out to pathologists across the country. "There were 187 pathologists kind enough to help us," says Elmore. "These pathologists spent up to 20 hours volunteering their time."
The 187 pathologists reviewed the same slides on two occasions, at least eight months apart. Elmore's research team compared the pathologists' diagnoses against the gold standard diagnosis for each slide as well as against their previous diagnosis of the same slide.