The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions
The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions
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DOI：
10.1038/sj.jid.5700993
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发表时间：
2007-12-01
影响因子：
6.5
通讯作者：
Menzies, Scott
中科院分区：
文献类型：
--
作者：
Pellacani, Giovanni;Guitera, Pascale;Menzies, Scott
在体内共焦反射显微镜最近显示了有前途的结果，黑色素瘤（MM）的诊断上的一个有限的系列。该研究的目的是评估共聚焦特征诊断MM的灵敏度和特异性，两名盲法专家观察者对351例可疑黑素细胞病变（136例MM和215例痣）的37个共聚焦特征进行了评估。采用卡方检验、多元判别分析和二元逻辑回归分析对诊断模型进行检验。黑色素瘤的主要特征是表皮排列紊乱，表皮内有Pagetoid细胞，交界处有无边缘的乳头和细胞突起，真皮上层有不典型的巢和明亮的有核细胞。另一方面，规则的真皮-表皮结构，没有pagetoid浸润和非典型细胞提示良性病变。136例黑色素瘤中有5例在组织病理学检查时伴有轻度非典型黑素细胞和偶见的pagetoid细胞，但共聚焦显微镜检查未确诊。然而，新的诊断模型显示，与以前提出的共聚焦显微镜算法相比，没有显着的改善。由于细胞方面的可视化，共聚焦显微镜似乎是有用的临床和皮肤镜可疑病变的第二级检查。
In vivo confocal reflectance microscopy recently showed promising results for melanoma ( MM) diagnosis on a limited series. The aim of the study was to evaluate the sensitivity and specificity of confocal features for the diagnosis of MM 351 equivocal melanocytic lesions (136 MMs and 215 nevi) were evaluated for 37 confocal features by two blinded expert observers. chi(2) test, multivariate discriminant analysis and binary logistic regression were performed for the identification of the significant features and for testing newly created diagnostic models. Melanomas were mostly characterized by epidermal disarray and pagetoid cells in the epidermis, non-edged papillae, and cellular atypia at the junction, and atypical nests and bright nucleated cells in the upper dermis. On the other hand, regular dermal-epidermal architecture, and absence of pagetoid infiltration and atypical cells were suggestive of benign lesions. Five out of 136 melanomas, with mildly atypical melanocytes and occasional pagetoid cells at histopathology, were not diagnosed by confocal microscopy. Nevertheless, new diagnostic models showed no significant improvement compared with the previously proposed confocal microscopy algorithm. Owing to the visualization of cellular aspects, confocal microscopy seems useful for second level examination of clinically and dermoscopically equivocal lesions.