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Gordon M, Daniel M, Ajiboye A, Uraiby H, Xu NY, Bartlett R, Hanson J, Haas M, Spadafore M, Grafton-Clarke C, Gasiea RY, Michie C, Corral J, Kwan B, Dolmans D, Thammasitboon S. A scoping review of artificial intelligence in medical education: BEME Guide No. 84. Med Teach 2024; 46:446-470. [PMID: 38423127 DOI: 10.1080/0142159x.2024.2314198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Artificial Intelligence (AI) is rapidly transforming healthcare, and there is a critical need for a nuanced understanding of how AI is reshaping teaching, learning, and educational practice in medical education. This review aimed to map the literature regarding AI applications in medical education, core areas of findings, potential candidates for formal systematic review and gaps for future research. METHODS This rapid scoping review, conducted over 16 weeks, employed Arksey and O'Malley's framework and adhered to STORIES and BEME guidelines. A systematic and comprehensive search across PubMed/MEDLINE, EMBASE, and MedEdPublish was conducted without date or language restrictions. Publications included in the review spanned undergraduate, graduate, and continuing medical education, encompassing both original studies and perspective pieces. Data were charted by multiple author pairs and synthesized into various thematic maps and charts, ensuring a broad and detailed representation of the current landscape. RESULTS The review synthesized 278 publications, with a majority (68%) from North American and European regions. The studies covered diverse AI applications in medical education, such as AI for admissions, teaching, assessment, and clinical reasoning. The review highlighted AI's varied roles, from augmenting traditional educational methods to introducing innovative practices, and underscores the urgent need for ethical guidelines in AI's application in medical education. CONCLUSION The current literature has been charted. The findings underscore the need for ongoing research to explore uncharted areas and address potential risks associated with AI use in medical education. This work serves as a foundational resource for educators, policymakers, and researchers in navigating AI's evolving role in medical education. A framework to support future high utility reporting is proposed, the FACETS framework.
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Affiliation(s)
- Morris Gordon
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
- Blackpool Hospitals NHS Foundation Trust, Blackpool, UK
| | - Michelle Daniel
- School of Medicine, University of California, San Diego, SanDiego, CA, USA
| | - Aderonke Ajiboye
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Hussein Uraiby
- Department of Cellular Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nicole Y Xu
- School of Medicine, University of California, San Diego, SanDiego, CA, USA
| | - Rangana Bartlett
- Department of Cognitive Science, University of California, San Diego, CA, USA
| | - Janice Hanson
- Department of Medicine and Office of Education, School of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Mary Haas
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maxwell Spadafore
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Colin Michie
- School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Janet Corral
- Department of Medicine, University of Nevada Reno, School of Medicine, Reno, NV, USA
| | - Brian Kwan
- School of Medicine, University of California, San Diego, SanDiego, CA, USA
| | - Diana Dolmans
- School of Health Professions Education, Faculty of Health, Maastricht University, Maastricht, NL, USA
| | - Satid Thammasitboon
- Center for Research, Innovation and Scholarship in Health Professions Education, Baylor College of Medicine, Houston, TX, USA
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Khamees D, Peterson W, Patricio M, Pawlikowska T, Commissaris C, Austin A, Davis M, Spadafore M, Griffith M, Hider A, Pawlik C, Stojan J, Grafton-Clarke C, Uraiby H, Thammasitboon S, Gordon M, Daniel M. Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71. Med Teach 2022; 44:466-485. [PMID: 35289242 DOI: 10.1080/0142159x.2022.2040732] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners. METHODS Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned. RESULTS Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment. CONCLUSIONS This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.
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Affiliation(s)
- Deena Khamees
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - William Peterson
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Teresa Pawlikowska
- Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Carolyn Commissaris
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrea Austin
- San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Mallory Davis
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maxwell Spadafore
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Max Griffith
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ahmad Hider
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Cameron Pawlik
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Stojan
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Hussein Uraiby
- School of Medicine, University of Leicester, Leicester, UK
| | | | - Morris Gordon
- Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Michelle Daniel
- San Diego School of Medicine, University of California, San Diego, CA, USA
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Grafton-Clarke C, Uraiby H, Abraham S, Kirtley J, Xu G, McCarthy M. Live streaming to sustain clinical learning. Clin Teach 2022; 19:282-288. [PMID: 35365976 DOI: 10.1111/tct.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/09/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated the need to develop teaching innovations that provide safe, authentic clinical encounters which facilitate experiential learning. In tandem with the dissemination of teleconsultation and online teaching, this pilot study describes, evaluates and justifies a multi-camera live-streaming teaching session to medical students from the clinical environment. APPROACH Multiple audio and video inputs capturing an outpatient clinic setting were routed through Open Broadcast Software (OBS) to create a customised feed streamed to remote learners through a videoconferencing platform. Sessions were conducted between September 2020 and March 2021. Twelve students sequentially interacted with a patient who held an iPad. Higher quality Go-Pro cameras captured the scene, allowing students to view the consultation from the patient and doctor's perspective. A consultant then conducted a 'gold standard' patient consultation observed by students. A faculty member remotely facilitated the session, providing pre-clinic teaching and debriefing. The equipment required with costing for a standard and low-cost version is described, as well as a set-up schematic and overview of ideal conditions and barriers encountered during trials. EVALUATION All students completed a post-participation questionnaire, rating the overall quality of the sessions as 9.7/10. The quality of online facilitation, utility of observing peers' and consultant interaction with the patient, opportunity for peer-to-peer learning and availability of multiple camera angles were particularly valued by students. IMPLICATIONS This innovation permits an authentic clinical interaction to be experienced by multiple students remotely, promoting equitable access to high-quality teaching, while maintaining the safety of students and patients.
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Affiliation(s)
- Ciaran Grafton-Clarke
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hussein Uraiby
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shalin Abraham
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joanne Kirtley
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gang Xu
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mark McCarthy
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
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Grafton-Clarke C, Uraiby H, Gordon M, Clarke N, Rees E, Park S, Pammi M, Alston S, Khamees D, Peterson W, Stojan J, Pawlik C, Hider A, Daniel M. Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 70. Med Teach 2022; 44:227-243. [PMID: 34689692 DOI: 10.1080/0142159x.2021.1992372] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The novel coronavirus disease was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations/innovation were implemented (description), their impact (justification), and 'how' and 'why' these were selected (explanation and rationale). METHODS The authors systematically searched four online databases up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance. RESULTS Fifty-five articles were included. Most were from North America (n = 40), and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources, and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content. CONCLUSIONS This review highlights the response of medical educators in deploying adaptations and innovations. Whilst few are new, the complexity, concomitant use of multiple methods and the specific pragmatic choices of educators offers useful insight to clinical teachers who wish to deploy such methods within their own practice. Future works that offer more specific details to allow replication and understanding of conceptual underpinnings are likely to justify an update to this review.
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Affiliation(s)
- Ciaran Grafton-Clarke
- School of Medicine, University of East Anglia, Norwich, UK
- School of Medicine, University of Leicester, Leicester, UK
| | - Hussein Uraiby
- School of Medicine, University of Leicester, Leicester, UK
| | - Morris Gordon
- Department of Pediatrics, Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Nicola Clarke
- Research Department of Medical Education, University College London, London, UK
| | - Eliot Rees
- Research Department of Medical Education, University College London, London, UK
- School of Medicine, Keele University, North Staffordshire, UK
| | - Sophie Park
- School of Medicine, University of East Anglia, Norwich, UK
| | - Mohan Pammi
- Section of Neonatology, Texas Children's Hospital, Houston, TX, USA
| | - Sebastian Alston
- Division of Clinical Sciences, Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Deena Khamees
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Cameron Pawlik
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ahmad Hider
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle Daniel
- University of Michigan Medical School, Ann Arbor, MI, USA
- San Diego School of Medicine, University of California, La Jolla, CA, USA
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Stojan J, Haas M, Thammasitboon S, Lander L, Evans S, Pawlik C, Pawilkowska T, Lew M, Khamees D, Peterson W, Hider A, Grafton-Clarke C, Uraiby H, Gordon M, Daniel M. Online learning developments in undergraduate medical education in response to the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 69. Med Teach 2022; 44:109-129. [PMID: 34709949 DOI: 10.1080/0142159x.2021.1992373] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic spurred an abrupt transition away from in-person educational activities. This systematic review investigated the pivot to online learning for nonclinical undergraduate medical education (UGME) activities and explored descriptions of educational offerings deployed, their impact, and lessons learned. METHODS The authors systematically searched four online databases and conducted a manual electronic search of MedEdPublish up to December 21, 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias. A third author resolved discrepancies. Findings were reported in accordance with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance. RESULTS Fifty-six articles were included. The majority (n = 41) described the rapid transition of existing offerings to online formats, whereas fewer (n = 15) described novel activities. The majority (n = 27) included a combination of synchronous and asynchronous components. Didactics (n = 40) and small groups (n = 26) were the most common instructional methods. Teachers largely integrated technology to replace and amplify rather than transform learning, though learner engagement was often interactive. Thematic analysis revealed unique challenges of online learning, as well as exemplary practices. The quality of study designs and reporting was modest, with underpinning theory at highest risk of bias. Virtually all studies (n = 54) assessed reaction/satisfaction, fewer than half (n = 23) assessed changes in attitudes, knowledge or skills, and none assessed behavioral, organizational or patient outcomes. CONCLUSIONS UGME educators successfully transitioned face-to-face instructional methods online and implemented novel solutions during the COVID-19 pandemic. Although technology's potential to transform teaching is not yet fully realized, the use of synchronous and asynchronous formats encouraged virtual engagement, while offering flexible, self-directed learning. As we transition from emergency remote learning to a post-pandemic world, educators must underpin new developments with theory, report additional outcomes and provide details that support replication.
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Affiliation(s)
- Jennifer Stojan
- Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mary Haas
- Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Satid Thammasitboon
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Lina Lander
- Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Sean Evans
- Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Cameron Pawlik
- Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Madelyn Lew
- Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deena Khamees
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - William Peterson
- Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ahmad Hider
- Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Hussein Uraiby
- School of Medicine, University of Leicester, Leicester, UK
| | - Morris Gordon
- Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Michelle Daniel
- Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
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Uraiby H, Grafton-Clarke C, Gordon M, Sereno M, Powell B, McCarthy M. Fostering intrinsic motivation in remote undergraduate histopathology education. J Clin Pathol 2021; 75:837-843. [PMID: 34429354 DOI: 10.1136/jclinpath-2021-207640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 11/04/2022]
Abstract
AIMS The levels of abstraction, vast vocabulary and high cognitive load present significant challenges in undergraduate histopathology education. Self-determination theory describes three psychological needs which promote intrinsic motivation. This paper describes, evaluates and justifies a remotely conducted, post-COVID-19 histopathology placement designed to foster intrinsic motivation. METHODS 90 fourth-year medical students took part in combined synchronous and asynchronous remote placements integrating virtual microscopy into complete patient narratives through Google Classroom, culminating in remote, simulated multidisciplinary team meeting sessions allowing participants to vote on 'red flag' signs and symptoms, investigations, histological diagnoses, staging and management of simulated virtual patients. The placement was designed to foster autonomy, competence and relatedness, generating authenticity, transdisciplinary integration and clinical relevance. A postpositivistic evaluation was undertaken with a validated preplacement and postplacement questionnaire capturing quantitative and qualitative data. RESULTS There was a significant (p<0.001) improvement in interest, confidence and competence in histopathology. Clinical integration and relevance, access to interactive resources and collaborative learning promoted engagement and sustainability post-COVID-19. Barriers to online engagement included participant lack of confidence and self-awareness in front of peers. CONCLUSIONS Fostering autonomy, competence and relatedness in post-COVID-19, remote educational designs can promote intrinsic motivation and authentic educational experiences. Ensuring transdisciplinary clinical integration, the appropriate use of novel technology and a focus on patient narratives can underpin the relevance of undergraduate histopathology education. The presentation of normal and diseased tissue in this way can serve as an important mode for the acquisition and application of clinically relevant knowledge expected of graduates.
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Affiliation(s)
- Hussein Uraiby
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK .,Leicester Medical School, University of Leicester, Leicester, UK
| | - Ciaran Grafton-Clarke
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Medical School, University of Leicester, Leicester, UK
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Marco Sereno
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Barbara Powell
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Mark McCarthy
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Medical School, University of Leicester, Leicester, UK
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Saldanha G, Yarrow J, Elsheikh S, O’Riordan M, Uraiby H, Bamford M. Development and Initial Validation of Calculated Tumor Area as a Prognostic Tool in Cutaneous Malignant Melanoma. JAMA Dermatol 2019; 155:890-898. [PMID: 31241720 PMCID: PMC6596334 DOI: 10.1001/jamadermatol.2019.0621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/07/2019] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Breslow thickness is a 1-dimensional surrogate prognostic feature for tumor size, yet tissue sections have 2 dimensions. Therefore, a 2-dimensional feature, calculated tumor area (CTA), was devised. OBJECTIVE To determine CTA precision and prognostic value. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort of patients with cutaneous melanoma presented to the Leicester and Nottingham National Health Service hospital trusts in the United Kingdom. Eligible patients in the Leicester development sample had available primary tumor tissue; a diagnosis from January 1, 2004, through December 31, 2011; invasive disease; and Leicestershire residency. Patients in the Nottingham validation sample had an anonymized spreadsheet with primary melanoma diagnosed from January 1, 2003, through December 31, 2005, or from January 1, 2008, through December 31, 2010. From a starting population of 1463 patients in both data sets, a total of 224 (15.3%) were excluded to yield a study population of 1239. Data were analyzed from April 30, 2018, through January 10, 2019. INTERVENTION An observational analysis of the prognostic value of CTA in patients with cutaneous melanoma. MAIN OUTCOMES AND MEASURES Independent association of CTA with melanoma-specific survival and confounding effect of CTA on Breslow thickness in survival analysis. RESULTS A total of 1239 patients with melanoma were assessed, including 649 (52.4%) women, with a median age of 60 years (interquartile range, 47-71 years). An intraclass correlation coefficient for CTA on 13 cases was 0.99. In 918 patients in the Leicester cohort, CTA was an independent prognostic factor in Cox proportional hazards regression models after adjusting for Breslow thickness, age, sex, ulcer, mitotic rate, and microsatellites (hazard ratio [HR], 1.87; 95% CI, 1.49-2.34; P < .001). Validation in 321 patients in the Nottingham cohort showed an HR of 1.55 (95% CI, 1.15-2.09; P = .005) and in the combined 1239 cases, an HR of 1.70 (95% CI, 1.43-2.03; P < .001). Breslow thickness was significant in multivariable analysis only when CTA was not in the model. The relative importance of CTA was shown by its retention in all 100 bootstrap multivariable models with backward selection, whereas Breslow thickness was retained in only 53. Melanomas stratified by CTA showed wider separation of survival curves than those stratified by Breslow thickness using the American Joint Committee on Cancer Staging Manual, 8th Edition (HRs, 1.00 to 41.46 vs 1.00 to 36.95, respectively), and the model with CTA categories had a Bayesian information criterion difference of 13.9 compared with T category, indicating substantially better fit. This model had a Harrell C index of 83.7%, and bootstrap analysis showed little evidence of model optimism, with a corrected calibration slope of 0.99. CONCLUSIONS AND RELEVANCE This study provides a novel microscopic feature, CTA, with evidence of its independent prognostic value. This evidence suggests that CTA should be a priority for further study.
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Affiliation(s)
- Gerald Saldanha
- Leicester Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Jeremy Yarrow
- Leicester Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Somaia Elsheikh
- Department of Cellular Pathology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Marie O’Riordan
- Department of Cellular Pathology, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Hussein Uraiby
- Department of Cellular Pathology, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Mark Bamford
- Department of Cellular Pathology, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
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