Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer
Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer
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DOI：
10.1200/jco.2005.05.0864
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发表时间：
2006-04-20
影响因子：
45.3
通讯作者：
Malvehy, J
中科院分区：
文献类型：
--
作者：
Argenziano, G;Puig, S;Malvehy, J
目的初级保健医生 (PCP) 是旨在加强皮肤癌筛查和预防的新干预措施和教育活动的适当目标。这项随机研究的目的是确定皮肤镜检查作为标准临床检查的辅助手段是否可以提高 PCP 对提示皮肤癌的病变进行分类的准确性。 患者和方法西班牙巴塞罗那和意大利那不勒斯的 PCP 接受了为期 1 天的皮肤癌检测和皮肤镜评估培训课程，并被随机分配到皮肤镜评估组或肉眼评估组。在 16 个月的时间里，73 名医生对 2,522 名前往其诊所就诊的皮肤病变患者进行了评估，并将个别病变评分为良性或提示皮肤癌。所有患者均由诊所的皮肤科医生专家重新评估色素病变。两个 PCP 组的转诊准确性均通过评分计算，并与皮肤科医生的评分进行比较。 结果：裸眼组的转诊敏感性、特异性以及阳性和阴性预测值分别为 54.1%、71.3%、11.3% 和 95.8%，而在肉眼组中分别为 79.2%、71.8%、16.1% 和 98.1%。 皮肤镜检查臂。敏感性和阴性预测值存在显着差异（分别为 P = .002 和 P = .004）。对可疑病变的组织病理学检查显示，PCP 进行肉眼观察时漏掉了 23 例恶性皮肤肿瘤，而 PCP 使用皮肤镜检查仅漏掉了 6 例 (P = .002)。 结论 使用皮肤镜检查提高了 PCP 对提示皮肤癌的病变进行分类的能力，而不会增加不必要的专家会诊次数。
PurposePrimary care physicians (PCPs) constitute an appropriate target for new interventions and educational campaigns designed to increase skin cancer screening and prevention. The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard clinical examination improves the accuracy of PCPs to triage lesions suggestive of skin cancer.Patients and MethodsPCPs in Barcelona, Spain, and Naples, Italy, were given a 1-day training course in skin cancer detection and dermoscopic evaluation, and were randomly assigned to the dermoscopy evaluation arm or naked-eye evaluation arm. During a 16-month period, 73 physicians evaluated 2,522 patients with skin lesions who attended their clinics and scored individual lesions as benign or suggestive of skin cancer. All patients were re-evaluated by expert dermatologists at clinics for pigmented lesions. Referral accuracy of both PCP groups was calculated by their scores, which were compared to those tabulated for dermatologists.ResultsReferral sensitivity, specificity, and positive and negative predictive values were 54.1%, 71.3%, 11.3%, and 95.8%, respectively, in the naked-eye arm, and 79.2%, 71.8%, 16.1%, and 98.1%, respectively, in the dermoscopy arm. Significant differences were found in terms of sensitivity and negative predictive value (P = .002 and P = .004, respectively). Histopathologic examination of equivocal lesions revealed 23 malignant skin tumors missed by PCPs performing naked-eye observation and only six by PCPs using dermoscopy (P = .002).ConclusionThe use of dermoscopy improves the ability of PCPs to triage lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.