Examples of GPT Diagnostic Ambiguity Score Analysis

Input Example #1

Pathology Report Text

"ENCAP MALIGNANT MELANOMA SUMMARY {P} Site and Procedure: Shave biopsy, right cheek Histological type: Lentigo maligna melanoma Tumour thickness (Breslow): At least 0.6mm Level of invasion (Clark): At least 2Mitotic rate: 0/mm2 A Ulceration: AbsentTumour-infiltrating lymphocytes: Not able to be assessedVascular invasion: Not able to be assessed accurately Superficial margins of excision: InvolvedDeep margin of excision: Involved Clinical History Slide No HI-14055/13 {P} A Shave biopsy (central, incl dark areas): 1. Right malar cheek 15x23mm irregular multicoloured growing lesion with x2 dark areas ?LM/?LMM (stitch at inferior apex) excision. 2. Right upper lip 4mm pearly lesion ?BCC. Macro1. Right malar cheek: Two pieces of skin shaving tissues. One measures 7x5x1mm with mid to dark brown lesion occupying the entire surface. Bisected. Ae. The other measures 3x3x less than 1mm with a roughened surface. Ae. 1Ax3. 2. Right upper lip: Triangular piece of skin 5mm base, 9mm and 10mm on both sides to a depth of 4mm with a mid brown towards the base 4x3mm. There is a suture at the apex. With the suture at 12 o'clock, the 3 o'clock is inked green and the 9 o'clock is inked black. Blocks: A-1LS, to 12 o'clock. B-2TS, to 6 o'clock. 2Ax1(LS), 2Bx2(TS). All in. (ap/sh/pg ) Micro1. The shave biopsy shows an atypical proliferation of melanocytes in which there are junctional melanocytes arranged both as single cells as nests along the basal layer of the epidermis as well as along skin appendages. The junctional melanocytes show architectural disarray and moderate to marked cytological atypia. There are also nests of atypical melanocytes which appear to be in the superficial dermis and the features here are best regarded as representing lentigo maligna melanoma. Accurate assessment of the depth of invasion is not possible on this shave biopsy which shows the tumour cells invading to at least 0.6mm and extending to the deep margin. Single atypical junctional melanocytes extend to the peripheral margins of the specimen. The dermis also shows chronic inflammation and pigment incontinence. 2. The lesion is a basal cell carcinoma exhibiting a nodular pattern of growth. Tumour cells extend to mid dermis. Excision of the carcinoma is complete with a clearance of 1mm from the 9 o'clock margin. CONCLUSION A 1. Shave biopsy, R cheek: Lentigo maligna melanoma, please see synoptic A report. A 2. Skin, right upper lip: Nodular basal cell carcinoma, completely excised."

Output Example #1

GPT Diagnostic Ambiguity Score

Predicted ICD-10: C43.9 (Malignant melanoma of skin, unspecified).

# Question Result Details
1 Skin Specimen? Yes The specimen under examination is skin.
2 Probability of Invasive or Malignant Melanoma? 4/5 There is a high probability that the specimen harbors invasive or malignant melanoma.
3 Level of Diagnostic Ambiguity? 3/5 There is a moderate level of diagnostic ambiguity in determining the specimen's benign or malignant nature.
4 Consider Melanoma Genomic Test? Yes Performing a melanoma genomic test on the specimen would likely help resolve the diagnostic ambiguity present.

Q1. Skin Specimen?

The provided text suggests that the specimen under examination is skin. This is indicated by the description of the site and procedure as a shave biopsy on the right cheek, which is a common method for obtaining skin samples for histopathological analysis. The mention of "skin shaving tissues" and the description of the specimen as pieces of skin further support the conclusion that the specimen is indeed skin. The histological findings, such as the presence of melanocytes along the basal layer of the epidermis and the invasion of tumor cells into the dermis, also align with the examination of skin tissue. Therefore, based on the information provided, it can be confidently stated that the specimen in question is skin.

Q2. Probability of Invasive or Malignant Melanoma?

Based on the provided text, there is a high probability (4/5) that the specimen in question harbors invasive or malignant melanoma. The histopathology report mentions the presence of lentigo maligna melanoma, which is a type of melanoma that typically exhibits slow growth and spreads horizontally along the skin surface. The report also indicates the invasion of tumor cells to at least 0.6mm depth, suggesting the potential for malignancy. However, further information such as the presence of ulceration, tumor-infiltrating lymphocytes, and vascular invasion is not able to be assessed accurately, which may contribute to the level of uncertainty in determining the malignancy. Therefore, additional diagnostic tests or further evaluation may be necessary to confirm the presence of invasive or malignant melanoma.

Q3. Level of Diagnostic Ambiguity?

The level of diagnostic ambiguity in the pathological findings is high, with a score of 4 out of 5. This indicates that there is significant uncertainty in determining whether the specimen is benign or malignant. The histopathology report describes features suggestive of lentigo maligna melanoma, such as atypical proliferation of melanocytes and invasion to at least 0.6mm. However, accurate assessment of the depth of invasion is not possible on the shave biopsy. Additionally, the report mentions chronic inflammation and pigment incontinence in the dermis, which further adds to the diagnostic ambiguity. Further evaluation and additional tests may be necessary to reach a definitive diagnosis.

Q4. Melanoma Genomic Test?

Performing a melanoma genomic test on the specimen referred to in the report would likely help resolve the diagnostic ambiguity present. The test is a microRNA test designed to quantify the level of malignancy present in melanocytic skin tissue. By analyzing the expression levels of specific microRNAs, the test can provide valuable information about the aggressiveness and malignant potential of the melanoma. This can aid in determining the appropriate treatment plan and prognosis for the patient. The genomic test can provide additional molecular insights that complement the histopathological findings, helping to confirm or refine the diagnosis of melanoma and guide clinical decision-making.


Input Example #2

Pathology Report Text

"ENCAPHISTOPATHOLOGY REF: 2013/2941/mas/mba ********** CLINICAL HISTORY EE 1) Excision Bx ? LM left ant neck/submandibular, 2) Left paravert L1 ? *****'s, 3) Right paravert T10 ? ***. MACROSCOPY 1) Left anterior neck - Ellipse of skin 14 x 4 x 2mm with a variegated pigmented skin surface. 5TS. All in. 1 block. 2) Left paravert L1 - A core of skin 2mm in diameter with a depth of 2mm. Processed whole. 1 block. 3) Right paravert T10 - A core of skin 2mm in diameter with a depth of 2mm. Processed whole. 1 block. sc MICROSCOPY 1) The sections show severely sun-damaged hair-bearing skin including mid reticular dermis. The sections confirm the presence of an atypical predominantly nested junctional melanocytic proliferation compatible with ***** LEVEL 1 (IN-SITU) MELANOMA, **********'S MELANOTIC FRECKLE/LENTIGO MALIGNA SUBTYPE. Dermal invasion is not identified. The melanoma in-situ comes within 0.05mm of the nearest margin (peripheral/superficial). SYNOPTIC SUMMARY Diagnosis: ***** LEVEL 1 (IN-SITU) MELANOMA, **********'S MELANOTIC FRECKLE/LENTIGO MALIGNA SUBTYPE. Specimen type: Elliptical excision of skin, left anterior neck. Margins of excision: In-situ component, nearest peripheral margin: 0.05mm Deep margin: 0.8mm Ulceration: Absent. Level of invasion (*****): 1 (non-invasive) Regression: Not identified. There is mild pigment incontinence. Solar elastosis: Present, severe. Tumour infiltrating lymphocytes: Not identified. Associated benign melanocytic lesion: Not identified. Predominant cell type: Small epithelioid with hyperchromatic nuclei, dusty cytoplasmic pigment and occasional multinucleate basal melanocytes. Intraepidermal growth pattern: Predominantly small distorted junctional nests of hyperchromatic melanocytes distributed in a markedly irregular fashion along with smaller foci of basal lentiginous melanocytic proliferation of atypical small medium-sized epithelioid melanocytes. 2) At one edge of the biopsy there is a lichenoid MILDLY DYSPLASTIC SOLAR KERATOSIS with slight acantholysis. There is no invasive malignancy. 3) The punch biopsy of skin includes deep reticular dermis. There is an atypical junctional and lentiginous melanocytic proliferation including multinucleate melanocytes and extending to one peripheral biopsy edge. There is some papillary dermal fibrosis and superficial perivascular lymphocytic inflammation. Pagetoid proliferation and confluence are not observed. Dermal invasion is not identified. COMMENT/INTERPRETATION: The features are suspicious for ***** level 1 (in-situ) melanoma, and the differential diagnosis is dysplastic junctional naevus. SUMMARY DIAGNOSIS 1) SKIN EXCISION, LEFT ANTERIOR NECK - ***** LEVEL 1 (IN-SITU) MELANOMA, VERY CLOSE TO PERIPHERAL MARGIN (0.05mm), EXCISION MAY BE INCOMPLETE. A 2) SKIN PUNCH BIOPSY, LEFT PARAVERTEBRAL L1 - MILDLY DYSPLASTIC SOLAR KERATOSIS, PARTIAL BIOPSY. A 3) SKIN PUNCH BIOPSY, RIGHT PARAVERTEBRAL T10 - ATYPICAL JUNCTIONAL AND LENTIGINOUS MELANOCYTIC PROLIFERATION A SUSPICIOUS FOR MELANOMA IN-SITU, PARTIAL BIOPSY."

Output Example #2

GPT Diagnostic Ambiguity Score

Predicted ICD-10: D03.9 (Melanoma in situ, unspecified).

# Question Result Details
1 Skin Specimen? Yes The text mentions excision of skin in the left anterior neck.
2 Probability of Invasive or Malignant Melanoma? 1/5 The report indicates a diagnosis of level 1 (in-situ) melanoma, which is non-invasive.
3 Level of Diagnostic Ambiguity? 2/5 The report suggests some uncertainty but leans towards a diagnosis of melanoma in-situ.
4 Consider Melanoma Genomic Test? No The report provides a clear diagnosis of melanoma in-situ, so a genomic test may not be necessary.

Q1. Skin Specimen?

The provided text suggests that the specimen under examination was skin. This is indicated by the description of an excision biopsy of skin in the left anterior neck. The macroscopic examination mentions an ellipse of skin with a variegated pigmented surface, further confirming that the specimen is skin tissue. Additionally, the microscopic examination describes sections showing severely sun-damaged hair-bearing skin, which further supports the conclusion that the specimen is skin. Overall, the information provided in the report strongly indicates that the specimen being analyzed is skin tissue.

Q2. Probability of Invasive or Malignant Melanoma?

Based on the provided text, the probability that the specimen(s) harbor invasive or malignant melanoma is assessed to be 1 out of 5. The histopathology report indicates a diagnosis of level 1 (in-situ) melanoma, which suggests that the melanocytic proliferation is confined to the epidermis and has not invaded the deeper layers of the skin. This indicates a non-invasive form of melanoma. However, it is important to note that the report does not mention the presence of dermal invasion, which is a key factor in determining the malignant potential of melanoma. Therefore, the probability of invasive or malignant melanoma is relatively low based on the information provided.

Q3. Level of Diagnostic Ambiguity?

TheThe level of diagnostic ambiguity in the pathological findings is assessed to be 2 out of 5. The report indicates some uncertainty between a diagnosis of melanoma in-situ and a dysplastic junctional naevus. While the presence of an atypical predominantly nested junctional melanocytic proliferation is compatible with level 1 (in-situ) melanoma, there is also mention of a differential diagnosis of dysplastic junctional naevus. This suggests a mild ambiguity in determining the specimen's benign or malignant nature. However, the report does not indicate a moderate or higher level of ambiguity, indicating that the diagnosis leans more towards melanoma in-situ.

Q4. Melanoma Genomic Test?

The report does not indicate a moderate or higher level of ambiguity in the diagnosis, suggesting that performing a melanoma genomic test on the specimen referred to in the report would not be likely to help resolve any diagnostic ambiguity. The level of diagnostic ambiguity is assessed as 2 out of 5, indicating mild uncertainty between a diagnosis of melanoma in-situ and a dysplastic junctional naevus. However, the report does not indicate a need for further testing to clarify the diagnosis. Therefore, a melanoma genomic test is not recommended in this case.


Input Example #3

Pathology Report Text

"HISTOPATHOLOGY REF: 2013***960/fna/rmc ********** CLINICAL INFORMATION ?*** small nodule (R) scalp - curettings. MACROSCOPIC DESCRIPTION Site not stated on container. Specimen consists of a skin curette measuring 5mm in maximum extent. Fragments in 1 block. All embedded. (Y1/MT) MICROSCOPIC DESCRIPTION Sections of the curettings from the right scalp show fragments of a spindle cell neoplasm that in one piece, which appears to be vertically orientated, measures 1mm thick with a streaming pattern of atypical spindle cells with mitotic figures present which appear non-atypical in type. In discussion with my ********* Dr **********************, we agree that the differential diagnosis is between a spindle cell squamous cell carcinoma, an atypical fibroxanthoma, and a malignant melanoma. Immunostains will be done, and he will issue a further report as I will be on leave. CONCLUSION RIGHT SCALP -- SPINDLE CELL NEOPLASM. FURTHER REPORT TO FOLLOW. Reported by Dr ************* (Direct Phone No. *********) SYNOPTIC REPORT FOR CUTANEOUS MALIGNANT MELANOMA. A Site: Diagnosis: Type/Classification: Predominant cell type: Breslow thickness: Clark Level: Ulceration present: Dermal mitotic count: (per mm2) Vascular space invasion: Perineural invasion: Microsatellites: Features of regression: A - Tumour infiltrating lymphocytes (TILS): - Capillary proliferation: - Loss of rete ridges: - Fibrosis: Associated naevus (include type): Closest peripheral margin to in-situ component: Closest peripheral margin to invasive component: Distance to deep margin: LYMPH NODESTotal number: Number involved: Sentinel node (s): Number , Positive on H&E: Extranodal spread: AJCC (TNM) PATHOLOGICAL STAGING A pT, pN,Mx Stage"

Output Example #3

GPT Diagnostic Ambiguity Score

Predicted ICD-10: C43.9 (Malignant melanoma of skin, unspecified).

# Question Result Details
1 Skin Specimen? Yes The text mentions 'Specimen consists of a skin curette'
2 Probability of Invasive or Malignant Melanoma? 3/5 The differential diagnosis includes spindle cell squamous cell carcinoma, atypical fibroxanthoma, and malignant melanoma. Further testing is needed to determine the final diagnosis.
3 Level of Diagnostic Ambiguity? 4/5 The report balances between a spindle cell squamous cell carcinoma, atypical fibroxanthoma, and malignant melanoma without a clear direction. Further testing is needed for a definitive diagnosis.
4 Consider Melanoma Genomic Test? Yes Performing a melanoma genomic test on the specimen would likely help resolve the diagnostic ambiguity present.

Q1. Skin Specimen?

The provided text suggests that the specimen under examination was indeed skin. This is indicated by the description of a skin curette measuring 5mm in maximum extent. The mention of fragments in 1 block and the statement that all are embedded further supports the interpretation that the specimen is skin tissue. The absence of any indication of a different anatomical site or organ in the report reinforces the conclusion that the specimen is skin. Therefore, the answer to question 1 is "Yes"..

Q2. Probability of Invasive or Malignant Melanoma?

Based on the provided text, the probability that the specimen(s) in question harbor invasive or malignant melanoma is assessed to be 3 out of 5. The histopathology report mentions a differential diagnosis that includes malignant melanoma, indicating that there is a possibility of the specimen being malignant. However, further investigations, such as immunostains, are required to confirm the diagnosis. The presence of atypical spindle cells with mitotic figures suggests a potential malignancy, but additional information is needed to determine the exact nature of the neoplasm. Therefore, while there is a significant likelihood of the specimen being invasive or malignant melanoma, further testing and analysis are necessary for a definitive conclusion.

Q3. Level of Diagnostic Ambiguity?

The level of diagnostic ambiguity in the pathological findings is rated as 4 out of 5. The report indicates uncertainty between three possible diagnoses: spindle cell squamous cell carcinoma, atypical fibroxanthoma, and malignant melanoma. The language used in the report suggests that the diagnosis could lean either way, without a clear direction. This level of ambiguity indicates a significant challenge in determining the specimen's benign or malignant nature. Further investigation and additional tests may be necessary to reach a definitive conclusion.

Q4. Melanoma Genomic Test?

The AI score suggests that performing a melanoma genomic test on the specimen referred to in the report would be likely to help resolve the diagnostic ambiguity present. This test is designed to quantify the level of malignancy present in melanocytic skin tissue using microRNA analysis. By analyzing the genomic profile of the specimen, the test can provide additional information about the presence of specific genetic markers associated with malignant melanoma. This can help in confirming or ruling out the diagnosis of melanoma and provide a more accurate assessment of the specimen's nature. The genomic test can complement the histopathological analysis and aid in making a more informed and precise diagnosis.