Roush G C, Barnhill R L, Ernstoff M S, Kirkwood J M
Dermatopathology Division and Dermatology Service, Massachusetts General Hospital and Harvard Medical School, Boston 02114.
Br J Cancer. 1991 Aug;64(2):373-6. doi: 10.1038/bjc.1991.310.
The number and type of melanocytic nevi are among the most important known predictors of risk for cutaneous malignant melanoma. In this study, examinations of the skin were conducted by two to four clinicians on 153 patients with newly diagnosed melanoma, and the agreement among clinicians was quantified regarding number of nevi and freckling. The index of agreement (calculated as the intra-class correlation coefficient) was 59.7% and 69.0% for freckling on the right forearm and on the shoulders, respectively; agreement was above 50% for only one of six pairs of clinicians in examining freckling on the right forearm, while agreement was above 50% for four of the six pairs of clinicians in examination of freckling on the shoulder. For palpable nevi of the arms (used in at least two case-control studies as a predictor of risk), the agreement was 36.1% when computed for three examiners assessing 81 patients. However, for total arm nevi (both palpable and non-palpable), assessed on a subset of 48 patients, the agreement was 88.2%; this and other analyses indicated that the difficulty in achieving a consensus for palpable nevi lay in whether or not lesions were considered to be 'palpable' or 'non-palpable'. Agreement for total number of atypical nevi on the body and total number of all types of nevi were 87.4% and 91.8% respectively. These data suggest that the kinds of lesions on which agreement might be reached are total atypical nevi and total nevi of all types on the arms and on the entire body. Greater difficulty might be found in achieving consistency among investigators and among clinicians in examining individual patients with respect to freckling on the arms and 'palpable' nevi. However, some consistency was achieved even with these latter two clinical features.
黑素细胞痣的数量和类型是已知的皮肤恶性黑色素瘤最重要的风险预测因素。在本研究中，由两至四名临床医生对153例新诊断为黑色素瘤的患者进行皮肤检查，并对临床医生之间关于痣的数量和雀斑的一致性进行了量化。对于右前臂和肩部的雀斑，一致性指数（以组内相关系数计算）分别为59.7%和69.0%；在检查右前臂雀斑时，六对临床医生中只有一对的一致性高于50%，而在检查肩部雀斑时，六对临床医生中有四对的一致性高于50%。对于手臂上可触及的痣（在至少两项病例对照研究中用作风险预测指标），当由三名检查人员评估81名患者时，一致性为36.1%。然而，对于48例患者的一个亚组中评估的手臂总痣数（包括可触及和不可触及的），一致性为88.2%；这一结果和其他分析表明，在可触及痣方面难以达成共识的原因在于病变是否被认为是“可触及的”或“不可触及的”。身体上非典型痣总数和所有类型痣总数的一致性分别为87.4%和91.8%。这些数据表明，可能达成一致的病变类型是手臂和全身的非典型痣总数以及所有类型的痣总数。在检查手臂上的雀斑和“可触及的”痣时，研究人员和临床医生在个体患者之间达成一致性可能会有更大困难。然而，即使是后两个临床特征也达成了一定程度的一致性。
