Abstract
Purpose :
Previous studies of ophthalmology attendings’ clinical diagnosis of periocular lesions suggest a high degree of accuracy. We performed a retrospective, observational, quality improvement study to evaluate whether resident ophthalmologists provided an accurate clinical diagnosis of periocular lesions as compared to the final histopathologic diagnosis on biopsy.
Methods :
We reviewed the biopsy log of a resident-run oculoplastics clinic from 2/1/18 to 12/1/19 to identify the clinical and histopathologic diagnosis for biopsies of eyelid and tarsus lesions. Lesions without clear clinical diagnosis or narrow differential were excluded, as were those with uninterpretable or equivocal histopathologic findings. The ophthalmology resident’s clinical diagnosis and the pathologist’s final histopathologic diagnosis were compared for concordance with descriptive statistics. IRB exemption was obtained.
Results :
Of 150 biopsies identified, 120 were included. 22 were excluded for lack of clinical diagnosis; 4 were excluded for an uncertain histopathologic diagnosis; and 4 samples were inadequate. The clinical diagnosis was concordant with the histopathologic diagnosis in 94 of 120 biopsies (78.4%). Three lesions were malignant, all of which were correctly assessed as basal cell carcinomas. Among benign lesions, concordance was highest in lesions clinically diagnosed as hidrocystomas (18/20 biopsies, 90.0%), chalazia (10/12, 83.3%), and benign squamous papillomas/fibroepithelial polyps (35/45, 77.8%). Seborrheic keratosis (SK) was frequently clinically misdiagnosed. In 6/6 cases where the clinical diagnosis was SK, the pathology were concordant, but there were 14 additional cases of biopsy-proven seborrheic keratosis, the clinical diagnosis was verruca vulgaris, papilloma, basal cell carcinoma, or nevus.
Conclusions :
Ophthalmology residents had a high degree of accuracy in clinical diagnosis of benign periocular lesions. Seborrheic keratosis was frequently misdiagnosed clinically and was identified as an area for improved resident education. A limitation of this study is paucity of malignant lesions, as residents' accuracy in their diagnosis was not able to be assessed. In addition, this retrospective quality improvement study was limited in scope; factors not assessed included the reason for biopsy, the training level of the resident, and whether the resident's and attending's clinical diagnosis agreed.
This is a 2020 ARVO Annual Meeting abstract.