Pagnanelli G, Soyer H P, Argenziano G, Talamini R, Barbati R, Bianchi L, Campione E, Carboni I, Carrozzo A M, Chimenti M S, de Simoni I, Falcomatà V, Filipe Neto I, Francesconi F, Ginebri A, Hagman J, Marulli G C, Palamara F, Vidolin A P, Piemonte P, Soda R, Chimenti S
Department of Dermatology, University of Rome Tor Vergata, P.le dell'Umanesimo 10, 00144 Rome, Italy.
Br J Dermatol. 2003 Apr;148(4):698-702. doi: 10.1046/j.1365-2133.2003.05168.x.
Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective.
To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique.
Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean +/- SEM sensitivity, specificity and diagnostic accuracy, and kappa (kappa) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests.
There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the kappa intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training.
We demonstrated that Web-based training is an effective tool for teaching dermoscopy.
皮肤镜已被证明可提高黑色素瘤的诊断水平。然而，使用皮肤镜需要培训和专业知识才能有效。
确定基于互联网的课程是否是教授皮肤镜的合适工具，并评估模式分析和诊断算法对尚不熟悉该技术的同事的诊断价值。
16名非皮肤镜专家的同事在参加基于互联网的皮肤镜培训课程前后，被要求使用不同的诊断方法（即模式分析、ABCD规则、七点检查表和门齐斯方法）评估20个色素沉着性皮肤病变的皮肤镜图像。对16名参与者在培训前后的每种诊断方法评估平均±标准误敏感性、特异性和诊断准确性，以及观察者内一致性kappa（κ）值。均值之间的差异通过双尾Wilcoxon秩和检验进行评估。
与培训前相比，基于网络的培训后皮肤镜诊断黑色素瘤有显著改善。ABCD规则和门齐斯方法的敏感性和诊断准确性有显著提高。模式分析的敏感性也有显著提高，而七点检查表在培训前后评估中的敏感性值都很高。任何方法在培训前后的特异性均未发现显著差异。模式分析和ABCD规则在培训后的观察者内一致性kappa值有显著提高。对于七点检查表和门齐斯方法，培训前已经有很好的一致性，培训后没有显著改善。
我们证明基于网络的培训是教授皮肤镜的有效工具。
