Appropriate Use Criteria (AUC) for Ancillary Diagnostic Testing in Dermatopathology: New Recommendations for 11 tests and 220 clinical scenarios from the American Society of Dermatopathology AUC Committee.

Background Appropriate use criteria (AUC) provide patient-centered physician guidance in test selection. An initial set of AUC were reported by the American Society of Dermatopathology (ASDP) in 2018. AUC reflect evidence collected at single timepoints and may be affected by evolving evidence and experience. Objective Update and expand AUC for selected tests. Methods RAND/UCLA methodology used includes: 1) Literature review; 2) Review of previously-rated tests and previously-employed clinical scenarios; 3) Selection of previously-rated tests for new ratings; 4) Development of new clinical scenarios; 5) Selection of additional tests; 6) Three rating rounds with feedback and group discussion after rounds 1 and 2. Results For 220 clinical scenarios comprising lymphoproliferative (light chain clonality), melanocytic (CGH, FISH, RT-PCR, TERT promoter), vascular disorders (MYC), and inflammatory dermatoses (PAS, GMS) consensus by panel raters was reached in 172/220 (78%) scenarios, with 103/148 (70%) rated "usually appropriate" or "rarely appropriate" and 45/148 (30%), "appropriateness uncertain." Limitations The study design only measures appropriateness. Cost, availability, test comparison, and additional clinical considerations are not measured. The possibility that the findings of this study may be influenced by the inherent biases of the dermatopathologists involved in the study cannot be excluded. Conclusions AUC are reported for selected diagnostic tests in clinical scenarios that occur in dermatopathology practice. Adhering to AUC may reduce inappropriate test utilization and improve health care delivery. This article is protected by copyright. All rights reserved.