Dermoscopy of pyogenic granuloma: a morphological study
Dermoscopy of pyogenic granuloma: a morphological study
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DOI：
10.1111/j.1365-2133.2010.10040.x
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发表时间：
2010-12-01
影响因子：
10.3
通讯作者：
Malvehy, J.
中科院分区：
文献类型：
--
作者：
Zaballos, P.;Carulla, M.;Malvehy, J.
背景化脓性肉芽肿是一种常见的皮肤和粘膜良性血管病变，是无色素性/黑素性黑色素瘤和其他肿瘤的模拟物。目的探讨皮肤镜下与化脓性肉芽肿相关的结构和模式在大量病例中的诊断意义。方法从西班牙、意大利、奥地利和土耳其的大学医院收集122例化脓性肉芽肿和140例其他肿瘤(无色素性黑色素瘤28例，黑色素瘤转移7例，基底细胞癌22例，其他肿瘤83例)的数字皮肤镜图像。统计与化脓性肉芽肿相关的皮肤镜结构和类型的出现频率、敏感性、特异性、阳性预测值、阴性预测值、观察者内一致性和观察者间一致性。结果45%的化脓性肉芽肿可观察到血管结构(敏感性为45.1%，特异性为17.9%；P均为0.001)。“红色均质区”(RHA)、“白领”(WC)、“白色轨线”(WRL)和“血管结构”(VS)的组合构成了7个排他性模式。RHA、WC和WRL组合诊断化脓性肉芽肿的敏感性最高(22.1%；P<；0.001)，特异性为100%(P<；0.001)。另外两种模式(RHA+WC和RHA+WC+WRL+VS)与黑色素瘤相比显示出100%的特异性(分别为P<；0.001和P<；0.05)。结论尽管某些皮肤镜检查模式有助于化脓性肉芽肿的识别，但皮肤镜检查不能替代组织学检查，尤其是在有血管存在的情况下，因为不能排除黑色素瘤。
Background Pyogenic granuloma is a common, benign, vascular lesion of the skin and mucous membranes which is a simulator of amelanotic/hypomelanotic melanoma and other tumours.Objectives To determine the diagnostic significance of dermoscopic structures and patterns associated with pyogenic granulomas in a large series of cases. Methods Digital dermoscopic images of histopathologically proven cases of 122 pyogenic granulomas and 140 other tumours (28 amelanotic melanomas, seven melanoma metastases, 22 basal cell carcinomas and 83 other tumours) were collected from university hospitals in Spain, Italy, Austria and Turkey. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, intraobserver agreement and interobserver agreement of the dermoscopic structures and patterns associated with pyogenic granulomas were calculated.Results Vascular structures were observed in 45% of pyogenic granulomas (sensitivity of 45.1% and specificity of 17.9%; both P < 0.001). Seven exclusive patterns were made up from the combination of the structures 'reddish homogeneous area' (RHA), 'white collarette' (WC), 'white rail lines' (WRL) and 'vascular structures' (VS). The pattern composed of RHA, WC and WRL showed the highest sensitivity (22.1%; P < 0.001) and a specificity of 100% (P < 0.001) for pyogenic granulomas. Two other patterns (RHA + WC and RHA + WC + WRL + VS) showed 100% specificity when compared with melanoma (P < 0.001 and P < 0.05, respectively).Conclusions Even though some dermoscopic patterns are useful in the recognition of pyogenic granulomas, dermoscopy is not a substitute for histology, mostly when vessels are present, as melanoma cannot be ruled out.