Skin Cancer Diagnosis With Reflectance Confocal Microscopy Reproducibility of Feature Recognition and Accuracy of Diagnosis
Skin Cancer Diagnosis With Reflectance Confocal Microscopy Reproducibility of Feature Recognition and Accuracy of Diagnosis
复制标题
DOI：
10.1001/jamadermatol.2015.0810
复制
发表时间：
2015-10-01
期刊：
影响因子：
10.9
通讯作者：
Pellacani, Giovanni
中科院分区：
文献类型：
--
作者：
Farnetani, Francesca;Scope, Alon;Pellacani, Giovanni
重要性反射共聚焦显微镜(RCM)研究已经被用来确定皮肤肿瘤的诊断标准。然而，基于RCM的诊断依赖于操作员。因此，需要测试RCM标准的重复性。目的测试观察者间对先前发表的RCM描述符的识别的重复性以及基于RCM的皮肤癌诊断的准确性。设计、设置和参与者对在三级学术医学中心收集的一组RCM图像进行基于网络的观察性回顾性研究。来自6个国家的9位皮肤科医生(其中6位有3年的RCM经验)对100个经活检证实的病变进行了RCM研究，包括55个黑色素细胞痣、20个黑色素瘤、15个基底细胞癌、7个日光性雀斑或脂溢性角化病和3个光化性角化病。在2010年6月15日至2010年10月21日期间，参与研究的皮肤科医生对组织病理学诊断失明，评估了每个病变3幅RCM马赛克图像，以确定是否存在预定义的RCM描述符。主要结果和测量结果是确定了RCM描述符，评价者之间的一致性良好(。统计学检验，t=0.3)，判别分析显示与良恶性诊断独立相关。其他测量包括每个评估者诊断良恶性的敏感性和特异性，大多数诊断(由9名评估者中的5人给出)，以及有经验的RCM使用者与最近的RCM使用者。结果8个RCM描述符显示出良好的重复性，并与特定的诊断独立相关。其中，页面状细胞、真皮-表皮交界处的非典型细胞和不规则的表皮结构与黑色素瘤有关。特殊的连接方式、基底细胞样索和溃疡与基底细胞癌有关。环状交界型和真皮巢与雀斑相关。评价者组的平均敏感度为88.9%(82.9%~100%)，平均特异度为79.3%(69.2%~90.8%)。多数诊断的敏感性为100%，特异性为80.0%。有经验的RCM使用者的敏感度高于近期的RCM使用者(91.0%比84.8%)，但特异度相似(80.0%比77.9%)。结论和相关性本研究强调了RCM使用者可重复识别的黑色素瘤和基底细胞癌的关键RCM诊断标准。诊断准确率随着经验的增加而提高。大多数诊断的较高准确率表明，RCM图像中固有的诊断信息比单个评估者目前使用的更多。
IMPORTANCE Reflectance confocal microscopy (RCM) studies have been performed to identify criteria for diagnosis of skin neoplasms. However, RCM-based diagnosis is operator dependent. Hence, reproducibility of RCM criteria needs to be tested.OBJECTIVE To test interobserver reproducibility of recognition of previously published RCM descriptors and accuracy of RCM-based skin cancer diagnosis.DESIGN, SETTING, AND PARTICIPANTS Observational retrospective web-based study of a set of RCM images collected at a tertiary academic medical center. Nine dermatologists (6 of whom had >= 3 years of RCM experience) from 6 countries evaluated an RCM study set from 100 biopsy-proven lesions, including 55 melanocytic nevi, 20 melanomas, 15 basal cell carcinomas, 7 solar lentigines or seborrheic keratoses, and 3 actinic keratoses. Between June 15, 2010, and October 21, 2010, participanting dermatologists, blinded to histopathological diagnosis, evaluated 3 RCM mosaic images per lesion for the presence of predefined RCM descriptors.MAIN OUTCOMES AND MEASURES The main outcome was identification of RCM descriptors with fair to good interrater agreement (. statistic, >= 0.3) and independent correlation with malignant vs benign diagnosis on discriminant analysis. Additional measures included sensitivity and specificity for diagnosis of malignant vs benign for each evaluator, for majority diagnosis (rendered by >= 5 of 9 evaluators), and for experienced vs recent RCM users.RESULTS Eight RCM descriptors showed fair to good reproducibility and were independently associated with a specific diagnosis. Of these, the presence of pagetoid cells, atypical cells at the dermal-epidermal junction, and irregular epidermal architecture were associated with melanoma. Aspecific junctional pattern, basaloid cords, and ulceration were associated with basal cell carcinomas. Ringed junctional pattern and dermal nests were associated with nevi. The mean sensitivity for the group of evaluators was 88.9% (range, 82.9%-100%), and the mean specificity was 79.3%(range, 69.2%-90.8%). Majority diagnosis showed sensitivity of 100% and specificity of 80.0%. Sensitivity was higher for experienced vs recent RCM users (91.0% vs 84.8%), but specificity was similar (80.0% vs 77.9%).CONCLUSIONS AND RELEVANCE The study highlights key RCM diagnostic criteria for melanoma and basal cell carcinoma that are reproducibly recognized among RCM users. Diagnostic accuracy increases with experience. The higher accuracy of majority diagnosis suggests that there is intrinsically more diagnostic information in RCM images than is currently used by individual evaluators.