EPILUMINESCENCE MICROSCOPY - A USEFUL TOOL FOR THE DIAGNOSIS OF PIGMENTED SKIN-LESIONS FOR FORMALLY TRAINED DERMATOLOGISTS
EPILUMINESCENCE MICROSCOPY - A USEFUL TOOL FOR THE DIAGNOSIS OF PIGMENTED SKIN-LESIONS FOR FORMALLY TRAINED DERMATOLOGISTS
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DOI：
10.1001/archderm.131.3.286
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发表时间：
1995-03-01
影响因子：
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通讯作者：
PEHAMBERGER, H
中科院分区：
文献类型：
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作者：
BINDER, M;SCHWARZ, M;PEHAMBERGER, H
背景与设计：皮肤镜检查（ELM）是一种非侵入性技术，通过利用油浸的光学现象，使皮肤的皮下结构能够在活体检查中被观察到，从而为色素性皮肤病变的临床诊断提供了额外的标准。目前，几乎所有关于皮肤镜检查价值和临床重要性的研究都是基于皮肤镜检查专家（即经过该技术专门培训的皮肤科医生）的数据。在本研究中，我们试图确定使用皮肤镜检查是否能显著提高色素性皮肤病变的临床诊断水平，以及经过皮肤镜检查培训的人员和未经过该技术培训的皮肤科医生是否能从该技术中同等受益。随机选取经组织学证实的色素性皮肤病变标本，分别在使用（皮肤镜检查）和不使用油浸（表面显微镜检查）的情况下拍照，通过幻灯片投影展示给6名皮肤镜检查专家和13名非皮肤镜检查专家（即未经过皮肤镜检查正式培训的皮肤科医生）进行诊断。为了评估皮肤镜检查专家和非专家在使用和不使用油浸技术（即皮肤镜检查与表面显微镜检查）时的诊断性能，获取了以下参数：通过卡帕统计得出的观察者内和观察者间一致性，以及诊断性能的敏感性和特异性。
结果：我们的结果表明，通过使用皮肤镜检查技术，皮肤镜检查专家在观察者内一致性方面明显优于非专家（卡帕中位数，0.56对0.36）。皮肤镜检查专家组的观察者间一致性显著提高（平均提高7%），而非专家组则下降（平均下降6%）。皮肤镜检查专家组的诊断敏感性显著提高（平均提高10%），而非专家组则下降（平均下降10%）。最后，皮肤镜检查专家组在使用和不使用油浸的情况下诊断特异性都非常好（0.91），非专家组通过皮肤镜检查也有所提高（0.77对0.85）。
结论：我们得出结论，皮肤镜检查技术提高了经过正式培训的皮肤科医生的敏感性，但可能会降低未经过皮肤镜检查技术正式培训的皮肤科医生的诊断能力。因此，应该向皮肤科界提供全面的皮肤镜检查正式培训。
Background and Design: Epiluminescence microscopy (ELM) is a noninvasive technique that, by employing the optical phenomenon of oil immersion, makes subsurface structures of the skin accessible for in vivo examination and thus provides additional criteria for the clinical diagnosis of pigmented skin lesions. At present, almost all studies about the value and clinical importance of ELM are based on data derived from ELM experts (ie, dermatologists specifically trained in this technique). In the present study, we attempt to determine whether the clinical diagnosis of pigmented skin lesions is significantly improved using ELM and whether ELM-trained individuals and dermatologists not trained in this technique profit equally from this technique. Randomly selected histologically proven pigmented skin lesion specimens, photographed with (ELM) and without oil immersion (surface microscopy) were presented by slide projection to six ELM experts and 13 ELM nonexperts (ie, dermatologists not formally trained in ELM) for diagnosis. To evaluate the diagnostic performance of ELM experts and nonexperts with and without the oil immersion technique (ie, ELM vs surface microscopy), the following parameters were obtained: intraobserver and interobserver agreement by kappa statistics and sensitivity and specificity of diagnostic performance.Results: Our results show that by using the ELM technique the ELM experts reach a substantially better intraobserver agreement than nonexperts (median kappa, 0.56 vs 0.36). The interobserver agreement was markedly increased in the ELM experts group (average gain, 7%) but decreased in the ELM nonexperts group (average loss, 6%). The sensitivity of diagnosis was significantly increased in the ELM experts group (average gain, 10%), but decreased in the nonexperts group (average loss, 10%). Finally, the specificity of diagnosis was excellent in the ELM experts group, both with and without oil immersion (0.91) and was somewhat improved by ELM in the nonexperts group (0.77 vs 0.85).Conclusions: We conclude that the ELM technique increases sensitivity in formally trained dermatologists, but may decrease the diagnostic ability in dermatologists not formally trained in the ELM technique. Consequently, formal broad-based training in ELM should be offered to the dermatologic community.