Soyer H Peter, Argenziano Giuseppe, Zalaudek Iris, Corona Rosamaria, Sera Francesco, Talamini Renato, Barbato Filomena, Baroni Adone, Cicale Lorenza, Di Stefani Alessandro, Farro Pietro, Rossiello Luigi, Ruocco Eleonora, Chimenti Sergio
Department of Dermatology, University of Graz, Graz, Austria.
Dermatology. 2004;208(1):27-31. doi: 10.1159/000075042.
Dermoscopy used by experts has been demonstrated to improve the diagnostic accuracy for melanoma. However, little is known about the diagnostic validity of dermoscopy when used by nonexperts.
To evaluate the diagnostic performance of nonexperts using a new 3-point checklist based on a simplified dermoscopic pattern analysis.
Clinical and dermoscopic images of 231 clinically equivocal and histopathologically proven pigmented skin lesions were examined by 6 nonexperts and 1 expert in dermoscopy. For each lesion the nonexperts assessed 3 dermoscopic criteria (asymmetry, atypical network and blue-white structures) constituting the 3-point method. In addition, all examiners made an overall diagnosis by using standard pattern analysis of dermoscopy.
Asymmetry, atypical network and blue-white structures were shown to be reproducible dermoscopic criteria, with a kappa value ranging from 0.52 to 0.55. When making the overall diagnosis, the expert had 89.6% sensitivity for malignant lesions (tested on 68 melanomas and 9 pigmented basal cell carcinomas), compared to 69.7% sensitivity achieved by the nonexperts. Remarkably, the sensitivity of the nonexperts using the 3-point checklist reached 96.3%. The specificity of the expert using overall diagnosis was 94.2% compared to 82.8 and 32.8% achieved by the nonexperts using overall diagnosis and 3-point checklist, respectively.
The 3-point checklist is a valid and reproducible dermoscopic algorithm with high sensitivity for the diagnosis of melanoma in the hands of non-experts. Thus it may be applied as a screening procedure for the early detection of melanoma.
专家使用皮肤镜已被证明可提高黑色素瘤的诊断准确性。然而，非专家使用皮肤镜时的诊断有效性却知之甚少。
基于简化的皮肤镜图像分析，使用新的三点检查表评估非专家的诊断性能。
6名非专家和1名皮肤镜专家检查了231例临床诊断不明确且经组织病理学证实的色素性皮肤病变的临床和皮肤镜图像。对于每个病变，非专家评估构成三点法的3个皮肤镜标准（不对称性、非典型网络和蓝白色结构）。此外，所有检查人员均采用皮肤镜标准模式分析进行总体诊断。
不对称性、非典型网络和蓝白色结构被证明是可重复的皮肤镜标准，kappa值范围为0.52至0.55。进行总体诊断时，专家对恶性病变的敏感性为89.6%（在68例黑色素瘤和9例色素性基底细胞癌上进行测试），而非专家的敏感性为69.7%。值得注意的是，使用三点检查表的非专家的敏感性达到了96.3%。专家使用总体诊断的特异性为94.2%，相比之下，非专家使用总体诊断和三点检查表的特异性分别为82.8%和32.8%。
三点检查表是一种有效且可重复的皮肤镜算法，在非专家手中对黑色素瘤诊断具有高敏感性。因此，它可作为黑色素瘤早期检测的筛查程序。
