Improvement in precision of counting actinic keratoses

• Published in: British journal of dermatology (1951) Vol. 170; no. 1; pp. 188 - 191
• Main Authors: Lee, K.C., Lew, R., Weinstock, M.A.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.01.2014; Wiley-Blackwell
• Subjects: Biological and medical sciences; Consensus; Consensus Development Conferences as Topic; Dermatology; Dermatology - standards; Dyskeratosis; Humans; Injuries of the skin. Diseases of the skin due to physical agents; Keratosis, Actinic - pathology; Medical sciences; Middle Aged; Skin involvement in other diseases. Miscellaneous. General aspects; Skin Neoplasms - pathology; Traumas. Diseases due to physical agents; Dyskeratosis; Photosensitivity; Skin disease; Photodermatosis; Improvement; Dermatology; Hyperkeratosis; Keratosis senilis; Counting
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/bjd.12629

Summary Background Actinic keratoses (AKs) often serve as a primary endpoint for clinical studies. However, reliability of counting these lesions is poor, even among expert dermatologists. Objectives To investigate the reliability of counting AKs before and after a yearly consensus meeting, held annually for 4 years. Methods As part of the Veterans Affairs (VA) Keratinocyte Carcinoma Chemoprevention Trial, board‐certified dermatologists convened annually for 4 years to individually count the number of actinic keratoses on three to five test subjects. The dermatologists then met as a group for a consensus discussion on what constituted an AK lesion on each subject. Afterwards, each dermatologist repeated the independent counting exercise on three to five new subjects. The intraclass correlation coefficient (ICC) was used to analyze the reliability of counting AKs among the dermatologists. Results Eight dermatologists participated in this exercise for 4 consecutive years. Pre‐consensus discussion ICCs over 4 years were 0·18, 0·34, 0·38, 0·75, respectively, showing sustained improvement with each consensus discussion. The greatest improvement in reliability of AK counts was shown during the first year of consensus discussions, when the ICC improved from 0·18 to 0·67. There was no improvement by the fourth year of consensus discussion, with pre‐ and post‐consensus ICCs of 0·75 and 0·75, respectively. Conclusions Annual consensus discussions can lead to improvement in reliability of AK counts. This improvement was sustained over 4 years. By the fourth year, the discussion meeting had no effect on improvement in reliability. A consensus meeting discussion may be helpful for improving reliability in other trials. What's already known about this topic? The reliability of counting actinic keratoses (AKs) is poor to fair, even when performed by experienced dermatologists. What does this study add? This study examined the utility of a consensus discussion in improving reliability of counting AKs. The consensus discussion was held yearly for 4 years. Annual consensus discussion increased reliability, which improved progressively over 4 years.