Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997-2001
Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997-2001
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DOI：
10.1111/j.0007-0963.2004.05860.x
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发表时间：
2004-04-01
影响因子：
10.3
通讯作者：
Giannotti, B
中科院分区：
文献类型：
--
作者：
Carli, P;De Giorgi, V;Giannotti, B
背景由于基于切除病变的诊断设置的研究有许多局限性，皮肤镜检查的影响（发光显微镜，皮肤镜）在黑色素瘤筛查在实践中仍然有待建立。Objectives我们假设，在黑色素瘤筛查的诊断性能的一些指标上使用皮肤镜的影响应追溯;因此，我们分析了常规皮肤镜使用对切除的黑色素细胞病变的恶性/良性比率的影响。方法术前和组织学诊断3053例黑色素细胞病变[319例黑色素瘤（10.4%）]，连续诊断和切除的皮肤科，佛罗伦萨大学在1997年至2001年期间（含）。6名选择切除病变并进行术前诊断的皮肤科医生根据他们在日常活动中使用皮肤镜分为两组（n = 2皮肤镜使用者和n = 4非使用者）。研究期分为皮镜检查前（19 9 7 7）、换镜期（1998）和皮镜检查期（1999 ~ 2 0 0 1）。未使用者之间无显著差异（从1：11.8到1：14.4）。皮肤镜使用者比非使用者更有可能在一系列切除病变中诊断出黑色素瘤，即使通过多变量分析考虑了潜在的混杂因素，如性别、年龄和研究时间（比值比1.55，95%置信区间1.17-2.01）。皮肤镜使用者中“问题”痣（痣结构紊乱伴或不伴细胞学异常和Spitz痣或Reed痣）占切除病灶总数的百分比高于非使用者（2001年，51.6% vs. 40.9%，P = 0.014）。从数据集的病变切除美容reasons.Conclusions通过皮肤镜在常规黑色素瘤筛查排除后，获得了类似的结果，其次是改善切除病变的恶性/良性的比例，这表明一个更合适的选择色素性病变提到手术。由于回顾性研究设计的可能局限性，建议将来通过前瞻性随机研究来证实这一发现。在常规实践中引入皮肤镜检查可能对大规模黑色素瘤筛查产生重大影响，节省成本并减少皮肤外科工作量。
Background Because of the many limitations of studies based on the diagnostic setting of excised lesions, the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) in melanoma screening during practice remains to be established.Objectives We assumed that effects of the use of dermoscopy on some indicators of diagnostic performance in melanoma screening should be traceable retrospectively; therefore, we analysed the impact of routine dermoscopy use on the malignant/benign ratio in excised melanocytic lesions.Methods Preoperative and histological diagnosis of 3053 melanocytic lesions [319 melanomas (10.4%)] consecutively diagnosed and excised at the Department of Dermatology, University of Florence in the period 1997-2001 inclusive were retrieved. Six dermatologists who selected the lesions to excise and who performed preoperative diagnosis were divided into two groups according to their use of dermoscopy in routine activity (n = 2 dermoscopy users and n = 4 nonusers). The study period was divided into a predermoscopy period (19 9 7), a shift phase (1998) and a dermoscopy period (1999-2001).Results During the study period, the malignant/benign ratio improved in dermoscopy users only (from 1 : 18 to 1 : 4.3, P = 0.037). No significant difference was found for nonusers (from 1 : 11.8 to 1 : 14.4). Dermoscopy users were more likely to have a melanoma diagnosed within a series of excised lesions than nonusers, even taking into account potential confounders such as sex, age and study period by means of multivariate analysis (odds ratio 1.55, 95% confidence interval 1.17-2.01). The percentage of 'problem' naevi (naevi with architectural disorder with or without cytological atypia and Spitz or Reed naevi) over the total number of excised lesions was higher in dermoscopy users than in nonusers (year 2001, 51.6% vs. 40.9%, P = 0.014). Similar findings were obtained after exclusion from the data set of lesions excised for cosmetic reasons.Conclusions The adoption of dermoscopy in routine melanoma screening is followed by an improvement of the malignant/benign ratio in excised lesions, suggesting a more appropriate selection of pigmented lesions referred to surgery. Because of the possible limitations of a retrospective study design, future confirmation of this finding by means of a prospective, randomized study is advisable. The introduction of dermoscopy in routine practice may have major implications in large-scale melanoma screening with cost savings and a reduction of the dermosurgery workload.