THE ABCD RULE OF DERMATOSCOPY - HIGH PROSPECTIVE VALUE IN THE DIAGNOSIS OF DOUBTFUL MELANOCYTIC SKIN-LESIONS
THE ABCD RULE OF DERMATOSCOPY - HIGH PROSPECTIVE VALUE IN THE DIAGNOSIS OF DOUBTFUL MELANOCYTIC SKIN-LESIONS
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DOI：
10.1016/s0190-9622(94)70061-3
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发表时间：
1994-04-01
影响因子：
13.8
通讯作者：
PLEWIG, G
中科院分区：
文献类型：
--
作者：
NACHBAR, F;STOLZ, W;PLEWIG, G
背景：在实践中，准确评估色素性皮肤病变一直存在困难。最近描述的皮肤镜检查（放大10倍的皮肤表面显微镜检查）ABCD规则，基于不对称（A）、边界（B）、颜色（C）和差异结构（D）这些标准，在回顾性应用于临床玻片时提高了诊断准确性。
目的：设计一项研究以评估皮肤镜ABCD规则在黑素细胞性病变中的前瞻性价值。
方法：在172个黑素细胞性色素性皮肤病变中，在切除前用半定量评分系统分析皮肤镜ABCD规则的各项标准。
结果：根据回顾性确定的阈值，评分高于5.45的肿瘤（64/69个黑素瘤[92.8%]）被归类为恶性，而评分较低的病变被视为良性（93/103个黑素细胞痣[90.3%]）。黑素瘤的阴性预测值（真阴性除以[真阴性 + 假阴性]）为95.8%，而阳性预测值（真阳性除以[真阳性 + 假阳性]）为85.3%。黑素瘤的诊断准确性（真阳性除以[真阳性 + 假阳性 + 假阴性]）为80.0%，而肉眼诊断的准确性为64.4%。黑素瘤的最终皮肤镜平均评分是6.79（标准差，±0.92），与黑素细胞痣（平均评分，4.27 ± 0.99；p < 0.01，U检验）有显著差异。
结论：ABCD规则易于学习且能快速计算，并且已被证明是可靠的。它应该常规应用于所有不明确的色素性皮肤病变，以实现更客观和可重复的诊断，并在术前获得这种评估。
Background: The difficulties in accurately assessing pigmented skin lesions are ever present in practice. The recently described ABCD rule of dermatoscopy (skin surface microscopy at x10 magnification), based on the criteria asymmetry (A), border (B), color (C), and differential structure (D), improved diagnostic accuracy when applied retrospectively to clinical slides.Objective: A study was designed to evaluate the prospective value of the ABCD rule of dermatoscopy in melanocytic lesions.Methods: In 172 melanocytic pigmented skin lesions, the criteria of the ABCD rule of dermatoscopy were analyzed with a semiquantitative scoring system before excision.Results: According to the retrospectively determined threshold, tumors with a score higher than 5.45 (64/69 melanomas [92.8%]) were classified as malignant, whereas lesions with a lower score were considered as benign (93/103 melanocytic nevi [90.3%]). Negative predio tive value for melanoma (True-Negative divided by [True-Negative + False-Negative]) was 95.8%, whereas positive predictive value (True-Positive divided by [True-Positive + False-Positive]) was 85.3%. Diagnostic accuracy for melanoma (True-Positive divided by [True-Positive + False-Positive + False-Negative]) was 80.0%, compared with 64.4% by the naked eye. Melanoma showed a mean final dermatoscopy score of 6.79 (SD, +/- 0.92), significantly differing from melanocytic nevi (mean score, 4.27 +/- 0.99; p < 0.01, U test).Conclusion: The ABCD rule can be easily learned and rapidly calculated, and has proven to be reliable. It should be routinely applied to all equivocal pigmented shin lesions to reach a more objective and reproducible diagnosis and to obtain this assessment preoperatively.