The shifting paradigm in the management of giant congenital melanocytic nevi: review and clinical applications.
The shifting paradigm in the management of giant congenital melanocytic nevi: review and clinical applications.
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巨大先天性黑素细胞痣治疗模式的转变：回顾和临床应用。
DOI：
10.1097/prs.0000000000000546
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发表时间：
2014
影响因子：
3.6
通讯作者：
A. Marghoob
中科院分区：
文献类型：
--
作者：
B. Bauer;S. Dickie;A. Marghoob
我可以比较每个审稿人的结果。为了试图弥补我们所认识到的分歧，我们创建了轻度（0到I），中度（IIA），严重（IIB到III）分类。这一结果提高了评级的一致性，但比我们预期的要少。在第二次尝试中，为了弥补质量可接受标准的缺乏，我们利用Fleiss kappa统计3来评估所有研究参与者之间的解释器变异性。我们再次发现审稿人之间缺乏一致性（κ = 0.238, 0.438）。虽然Kaban等人批评本研究测试了审稿人对Pruzansky修改的Kaban分类的理解的应用，但这确实是Pruzansky修改目前在临床实践中的应用方式。分类图式通过易于理解和最终可复制而获得其有效性和临床意义。我们的结果表明，当与现代成像方式配对时，这两种情况都不可能发生在Pruzansky修改的Kaban分类系统上。毫无疑问，普鲁赞斯基修正仍然是一种选择的分类系统；我们的每一位研究参与者——训练有素的颅面外科医生——都承认在他们的实践中使用了它。在进行研究调查之前，每个参与者都被展示了正确的Pruzansky修改的原始定义，IIA型下颌骨被定义为“形状异常”。我们为图1图例中的错误道歉；然而，正如Kaban等人定义的那样，对图像的错误标记是医生之间可能存在分歧的一个例子，我们在研究中对此表示赞赏。不过，我相信，我们一致认为，在这两种情况下，对选择的处理不会有什么不同。再次，我们感谢他们对我们研究的周到批评，并同意：“分类系统应该有助于疾病的诊断，改善临床医生之间的沟通，帮助预测疾病/畸形的进展，并指导研究。”我们希望利用现有的资源，我们能够进行一项研究，证明以可靠和可重复的方式对诊断为面肌短小症的患者进行分类是非常困难的。三维计算机断层扫描的使用使医生能够清楚地看到每一例面部短小症的复杂性。我们相信，在每个三维计算机断层扫描中可用的信息可能是以更客观的方式对这种极端无定形疾病进行分类的关键。DOI: 10.1097 / PRS.0000000000000705
659e could compare the results of each reviewer. In order to attempt to remedy the disagreements that we appreciated, we created the mild (0 to I), moderate (IIA), severe (IIB to III) classification. This result improved rater agreement, but by less than we would have expected. In a second attempt to remedy the lack of a quality accepted standard, we utilized the Fleiss kappa statistic3 to assess for interrater variability among all study participants. Again, we appreciated a lack of interrater agreement among reviewers (κ = 0.238, 0.438). While Kaban et al.’s criticism that this study tests the application of the reviewers’ understanding of the Pruzansky modification of the Kaban classification is well received, this is indeed the way the Pruzansky modification is currently being applied in clinical practice. A classification schema derives its efficacy and, thus, clinical import by being readily understood and ultimately reproducible. Our results indicate that neither may be true of the Pruzansky modification of the Kaban classification system when paired with modern imaging modalities. There is no debate that the Pruzansky modification remains the classification system of choice; each of our study participants—trained craniofacial surgeons—acknowledged using it in their practice. Each participant was shown the correct original definition of the Pruzansky modification prior to undertaking the study survey, with a type IIA mandible being defined as “abnormal in shape.” We apologize for the error in the legend of Figure 1; however, the mislabeling of the images as Kaban et al. define it is an example of a possible disagreement among physicians that we appreciated in our study. I believe, though, that we are in agreement that the treatment of choice would not differ in either of these cases. Again, we appreciate their thoughtful criticisms of our study and agree, “A classification system should aid in diagnosis of a condition, improve communication among clinicians, help predict progression of disease/ deformity, and guide research.” We hope that with the resources available to us, we were able to conduct a study that demonstrated the immense difficulty of classifying patients with a diagnosis of hemifacial microsomia in a reliable and reproducible manner. The use of threedimensional computed tomography has allowed physicians to clearly visualize the complexity of each case of hemifacial microsomia. We believe that the information available in each three-dimensional computed tomography scan may hold the key to classifying this extremely amorphous disorder in a more objective manner. DOI: 10.1097/PRS.0000000000000705