Ming Michael E, Levy Ross M, Hoffstad Ole J, Filip Jennifer, Gimotty Phyllis A, Margolis David J
Departments of Dermatology and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Arch Dermatol. 2004 Jun;140(6):730-5. doi: 10.1001/archderm.140.6.730.
To determine the validity of patient self-report of skin cancer history.
A cohort of patients was randomly selected from the case group in a prior case-control study involving skin cancer, and a second cohort was randomly selected from the controls of that study. Patient self-reported history (as determined by responses to a survey) was compared with the gold standard of chart documentation of a pathology report or a procedure note from Mohs micrographic surgery demonstrating skin cancer.
University-based outpatient dermatology clinic.
Three hundred patients were selected.
Patients were considered to have correctly classified their skin cancer history if their self-reported history was consistent with chart documentation.
We obtained chart information for 258 patients.Of those patients, 183 (70.9%) had chart documentation of nonmelanoma skin cancer, and 16 (6.2%) had chart documentation of a melanoma. Using chart documentation as the gold standard, we found that patients correctly identified their basal cell carcinoma status in 84.3% of cases; their squamous cell carcinoma status in 81.5% of cases; their overall nonmelanoma skin cancer status in 91.8% of cases; their melanoma status in 94.8% of cases; and their overall skin cancer status in 92.6% of cases. Patients' self-reported history of skin cancer of any type had a positive predictive value of 95.1% and a negative predictive value of 85.9%.
Self-reported history of skin cancer had a high degree of sensitivity and specificity and a high positive and negative predictive value within the study population. Obtaining medical information by patient report appears to be a useful tool for determining medical history of skin cancer.
确定患者自我报告皮肤癌病史的有效性。
在先前一项涉及皮肤癌的病例对照研究中，从病例组中随机选取一组患者，从该研究的对照组中随机选取另一组患者。将患者自我报告的病史（通过对一项调查的回答确定）与病理报告或莫氏显微外科手术的手术记录（显示皮肤癌）这一图表记录的金标准进行比较。
大学附属门诊皮肤科诊所。
选取了300名患者。
如果患者自我报告的病史与图表记录一致，则认为他们正确分类了自己的皮肤癌病史。
我们获取了258名患者的图表信息。在这些患者中，183名（70.9%）有非黑色素瘤皮肤癌的图表记录，16名（6.2%）有黑色素瘤的图表记录。以图表记录作为金标准，我们发现患者在84.3%的病例中正确识别了其基底细胞癌状况；在81.5%的病例中正确识别了其鳞状细胞癌状况；在91.8%的病例中正确识别了其总体非黑色素瘤皮肤癌状况；在94.8%的病例中正确识别了其黑色素瘤状况；在92.6%的病例中正确识别了其总体皮肤癌状况。患者自我报告的任何类型皮肤癌病史的阳性预测值为95.1%，阴性预测值为85.9%。
在研究人群中，自我报告的皮肤癌病史具有高度的敏感性和特异性，以及较高的阳性和阴性预测值。通过患者报告获取医疗信息似乎是确定皮肤癌病史的一种有用工具。
