Vestergaard M E, Macaskill P, Holt P E, Menzies S W
The Sydney Melanoma Diagnostic Centre and The Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
Br J Dermatol. 2008 Sep;159(3):669-76. doi: 10.1111/j.1365-2133.2008.08713.x. Epub 2008 Jul 4.
Dermoscopy is a noninvasive technique that enables the clinician to perform direct microscopic examination of diagnostic features, not seen by the naked eye, in pigmented skin lesions. Diagnostic accuracy of dermoscopy has previously been assessed in meta-analyses including studies performed in experimental and clinical settings.
To assess the diagnostic accuracy of dermoscopy for the diagnosis of melanoma compared with naked eye examination by performing a meta-analysis exclusively on studies performed in a clinical setting.
We searched for publications from 1987 to January 2008 and found nine eligible studies. The selected studies compare diagnostic accuracy of dermoscopy with naked eye examination using a valid reference test on consecutive patients with a defined clinical presentation, performed in a clinical setting. Hierarchical summary receiver operator curve analysis was used to estimate the relative diagnostic accuracy for clinical examination with, and without, the use of dermoscopy.
We found the relative diagnostic odds ratio for melanoma, for dermoscopy compared with naked eye examination, to be 15.6 [95% confidence interval (CI) 2.9-83.7, P = 0.016]; removal of two outlier studies changed this to 9.0 (95% CI 1.5-54.6, P = 0.03).
Dermoscopy is more accurate than naked eye examination for the diagnosis of cutaneous melanoma in suspicious skin lesions when performed in the clinical setting.
皮肤镜检查是一种非侵入性技术，可使临床医生对色素沉着性皮肤病变中肉眼不可见的诊断特征进行直接显微镜检查。皮肤镜检查的诊断准确性先前已在荟萃分析中进行评估，这些分析包括在实验和临床环境中进行的研究。
通过仅对在临床环境中进行的研究进行荟萃分析，评估皮肤镜检查与肉眼检查相比对黑色素瘤诊断的准确性。
我们检索了1987年至2008年1月的出版物，发现了9项符合条件的研究。所选研究在临床环境中对连续出现明确临床表现的患者使用有效参考测试，比较了皮肤镜检查与肉眼检查的诊断准确性。采用分层汇总接受者操作特征曲线分析来估计使用和不使用皮肤镜检查时临床检查的相对诊断准确性。
我们发现，与肉眼检查相比，皮肤镜检查诊断黑色素瘤的相对诊断比值比为15.6[95%置信区间（CI）2.9 - 83.7，P = 0.016]；剔除两项离群值研究后，该比值变为9.0（95%CI 1.5 - 54.6，P = 0.03）。
在临床环境中对可疑皮肤病变进行皮肤镜检查时，其对皮肤黑色素瘤诊断的准确性高于肉眼检查。
