Dermoscopy of pigmented skin lesions:: Results of a consensus meeting via the Internet
Dermoscopy of pigmented skin lesions:: Results of a consensus meeting via the Internet
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DOI：
10.1067/mjd.2003.281
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发表时间：
2003-05-01
影响因子：
13.8
通讯作者：
Wolff, K
中科院分区：
文献类型：
--
作者：
Argenziano, G;Soyer, HP;Wolff, K
背景：在评估色素性皮肤病变时，皮肤镜术语需要更好的标准化。
目的：组织皮肤镜虚拟共识网络会议以研究各种特征及诊断算法的可重复性和有效性。
方法：40名经验丰富的皮肤镜专家通过互联网使用两步诊断程序对108个病变的皮肤镜图像进行评估。第一步算法区分黑素细胞性病变和非黑素细胞性病变。诊断程序的第二步使用4种算法（模式分析、ABCD规则、孟席斯方法和7点检查表）来区分黑素瘤和良性黑素细胞性病变。对所有诊断算法和皮肤镜特征估计κ值、对数比值比、敏感度、特异度和阳性似然比。
结果：所有诊断方法的观察者间一致性为中等至良好，但大多数皮肤镜标准的观察者间一致性较差。所有考虑的算法和特征的观察者内一致性为良好至优秀。模式分析具有最佳诊断性能（阳性似然比：5.1），而其他算法显示出相当的敏感度但特异度较低。皮肤镜做出的处理决策的观察者间一致性相当好（平均κ值：0.53）。
结论：皮肤镜虚拟共识网络会议是使皮肤镜术语更好地标准化的有效工具，而且为色素性皮肤病变的诊断和处理开辟了新领域。
Background: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions.Objective: The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms.Methods: Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. kappa Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features.Results: Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean kappa value: 0.53).Conclusion: The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens Lip a new territory for diagnosing and managing pigmented skin lesions.