Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions
Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions
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DOI：
10.1001/archderm.143.3.329
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发表时间：
2007-03-01
影响因子：
--
通讯作者：
Marghoob, Ashfaq A.
中科院分区：
文献类型：
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作者：
Benvenuto-Andrade, Cristiane;Dusza, Stephen W.;Marghoob, Ashfaq A.
目的：通过使用常规皮肤镜检查和偏振光皮肤镜检查（PD）来评估皮肤病变的皮肤镜特征和模式。
设计：观察性研究。
地点：纪念斯隆 - 凯特琳癌症中心皮肤科诊所。
患者：90名有皮肤病变的患者。
干预措施：通过常规非偏振光接触式皮肤镜检查（NPD）、偏振光接触式皮肤镜检查（PCD）和偏振光非接触式皮肤镜检查（PNCD）对皮肤病变进行成像。
主要观察指标：由3名皮肤镜检查医师对3种检查方式所获得的图像进行颜色、结构和模式评估。通过一致性百分比和卡帕统计量评估检查方式之间的一致性水平。还对检查方式之间的定性差异进行了评估。
结果：对90个病变进行了回顾，其中包括55个黑素细胞性病变和35个非黑素细胞性病变。检查方式之间在整体皮肤镜模式上具有极好的一致性，卡帕值范围从0.88到1.00。对于大多数皮肤镜下的颜色，除蓝白色薄纱样结构和粉色（红色）外，具有中等到极好的一致性。对于大多数皮肤镜下的结构，除粟丘疹样囊肿外，具有尚可到完全一致。定性评估表明，与NPD图像相比，在PD上黑色素显得更暗，蓝痣有更多蓝色色调；在PD上血管和红色区域更易观察，这表明PD可能有助于识别恶性肿瘤；在NPD上粟丘疹样囊肿和粉刺样开口更易观察，这表明NPD对脂溢性角化病的识别更有帮助；在NPD下胡椒粉样结构、较浅颜色和蓝白色区域更明显，有助于识别消退区域；在PD下白色闪亮条纹（可能代表纤维化）更清晰可见。
结论：NPD、PCD和PNCD的能力并不等同，而是互补的。需要进一步研究来评估这些差异对临床诊断的影响。
Objective: To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized light dermoscopy (PD).Design: Observational study.Setting: Dermatology clinic at Memorial Sloan-Kettering Cancer Center.Patients: Ninety patients with skin lesions.Interventions: Skin lesions were imaged via conventional nonpolarized light contact dermoscopy (NPD), polarized light contact dermoscopy (PCD), and polarized light noncontact dermoscopy (PNCD).Main Outcome Measures: The images from the 3 modalities were evaluated by 3 dermoscopists for colors, structures, and patterns. Level of agreement between modalities was assessed by percentage agreement and the kappa statistic. Qualitative differences between modalities were also assessed.Results: Ninety lesions comprising 55 melanocytic and 35 nonmelanocytic lesions were reviewed. There was excellent agreement for overall dermoscopic patterns between modalities, with kappa values ranging from 0.88 to 1.00. There was moderate to excellent agreement for most dermoscopic colors, with the exception of blue-white veil and pink (red) color. Most dermoscopic structures had fair to perfect agreement, with the exception of milialike cysts. Qualitative assessment suggested that melanin appeared darker and blue nevi had more shades of blue on PD compared with NPD images; vessels and red areas were better visualized with PD, suggesting that PD may be helpful in identifying malignancies; milialike cysts and comedolike openings were better visualized with NPD, suggesting that NPD is more helpful for identification of seborrheic keratosis; peppering, lighter colors, and blue-white areas were more evident under NPD, facilitating recognition of regression areas; and shiny-white streaks, possibly representing fibrosis, were seen more clearly under PD.Conclusions: The capabilities of NPD, PCD, and PNCD are not equivalent, but complementary. Further studies are needed to evaluate the effect of these differences on clinical diagnosis.