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Evaluation of Terminology for Vascular Anomalies in Current Literature

Hassanein, Aladdin H. M.D.; Mulliken, John B. M.D.; Fishman, Steven J. M.D.; Greene, Arin K. M.D., M.M.Sc.

Plastic & Reconstructive Surgery: January 2011 - Volume 127 - Issue 1 - pp 347-351
doi: 10.1097/PRS.0b013e3181f95b83
Pediatric/Craniofacial: Special Topic

Background: A binary classification of vascular anomalies was approved 14 years ago by the International Society for the Study of Vascular Anomalies. The purpose of this study was to determine whether the International Society for the Study of Vascular Anomalies system is being used to categorize anomalies, and whether incorrect nomenclature affects patient care.

Methods: The PubMed database was searched for English language publications with the term “hemangioma” in the title/abstract during 2009. Outcome variables were (1) whether accepted nomenclature was used to describe the vascular anomaly and (2) whether or not patients received incorrect treatment. Predictive variables for terminological accuracy were patient age, location of the anomaly, and the primary author's medical specialty.

Results: “Hemangioma” was used incorrectly in 71.3 percent (228 of 320) of publications. Patients whose lesions were mislabeled were more likely to receive improper treatment (20.6 percent) compared with subjects whose lesions were designated using International Society for the Study of Vascular Anomalies terminology (0.0 percent) (p = 0.001). The patients were younger in articles that properly identified hemangioma (4.1 months) compared with articles that used hemangioma to describe another anomaly (36.1 years) (p < 0.0001). Publications focused on integument/soft-tissue lesions were more accurate (57.4 percent) than those in other anatomical areas (86.3 percent) (p < 0.0001). The erroneous use of hemangioma was independent of the authors' discipline: pediatrics (60.0 percent), internal medicine (61.4 percent), surgery (68.9 percent), and obstetrics/gynecology (70.0 percent) (p = 0.68).

Conclusions: Hemangioma continues to be commonly misused to describe any type of vascular anomaly, and terminological imprecision is prevalent among both medical and surgical fields. Inaccurate designation of the vascular anomaly is associated with an increased risk of erroneous management.

Boston, Mass.

From the Departments of Plastic and Oral Surgery and Surgery, Vascular Anomalies Center, Children's Hospital Boston, Harvard Medical School.

Received for publication May 14, 2010; accepted July 19, 2010.

Disclosure: No financial support or benefits were given to the authors from any source that is related to the scientific work reported in this article.

Arin K. Greene, M.D., M.M.Sc.; Department of Plastic and Oral Surgery; Children's Hospital Boston; 300 Longwood Avenue; Boston, Mass. 02115; arin.greene@childrens.harvard.edu

©2011American Society of Plastic Surgeons