Warshaw Erin M, Lederle Frank A, Grill Joseph P, Gravely Amy A, Bangerter Ann K, Fortier Lawrence A, Bohjanen Kimberly A, Chen Karen, Lee Peter K, Rabinovitz Harold S, Johr Robert H, Kaye Valda N, Bowers Sacharitha, Wenner Rachel, Askari Sharone K, Kedrowski Deborah A, Nelson David B
Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 55417, USA.
J Am Acad Dermatol. 2009 Apr;60(4):579-88. doi: 10.1016/j.jaad.2008.11.892. Epub 2009 Feb 13.
Studies of teledermatology utilizing the standard reference of histopathology are lacking.
To compare accuracy of store-and-forward teledermatology for non-pigmented neoplasms with in-person dermatology.
This study was a repeated-measures equivalence trial involving veterans with non-pigmented skin neoplasms. Each lesion was evaluated by an in-person dermatologist and a teledermatologist; both generated a primary diagnosis, up to two differential diagnoses, and management plan. The primary outcome was aggregated diagnostic accuracy (percent correct matches of any chosen diagnosis with histopathology). Secondary outcomes included management plan accuracy (percent correct matches with expert panel management plan). Additional analyses included evaluation of the incremental effect of using polarized light dermatoscopy in addition to standard macro images, and evaluating benign and malignant lesion subgroups separately.
Most of the 728 participants were male (97.8%) and Caucasian (98.9%). The aggregated diagnostic accuracy (primary outcome) of teledermatology (macro images) was not equivalent (95% confidence interval [CI] for difference within +/-10%) and was inferior (95% CI lower bound <10%) to in-person dermatology for all lesions and the subgroups of benign and malignant lesions. However, management plan accuracy was equivalent. Teledermatology aggregated diagnostic accuracy using polarized light dermatoscopy was significantly better than for macro images alone (P = .0017). The addition of polarized light dermatoscopy showed the same pattern for malignant lesions, but not for benign lesions. Most interestingly, for malignant lesions, the addition of polarized light dermatoscopy yielded equivalent aggregated diagnostic accuracy rates.
Non-diverse study population.
Using macro images, the diagnostic accuracy of teledermatology was inferior to in-person dermatology, but accuracy of management plans was equivalent. The addition of polarized light dermatoscopy yielded significantly better aggregated diagnostic accuracy, but management plan accuracy was not significantly improved. For the important subgroup of malignant lesions, the addition of polarized light dermatoscopy yielded equivalent diagnostic accuracy between teledermatologists and clinic dermatologists.
缺乏利用组织病理学标准参考进行远程皮肤病学研究。
比较存储转发式远程皮肤病学对非色素性肿瘤诊断的准确性与现场皮肤科诊断的准确性。
本研究是一项重复测量等效性试验，纳入患有非色素性皮肤肿瘤的退伍军人。每位皮肤科医生和远程皮肤科医生对每个病变进行评估；两者都给出初步诊断、最多两个鉴别诊断和治疗方案。主要结局是综合诊断准确性（任何选定诊断与组织病理学的正确匹配百分比）。次要结局包括治疗方案准确性（与专家小组治疗方案的正确匹配百分比）。额外分析包括评估除标准宏观图像外使用偏振光皮肤镜检查的增量效应，以及分别评估良性和恶性病变亚组。
728名参与者中大多数为男性（97.8%）且为白种人（98.9%）。远程皮肤病学（宏观图像）的综合诊断准确性（主要结局）不等效（差异的95%置信区间[CI]在+/-10%以内），并且对于所有病变以及良性和恶性病变亚组均低于现场皮肤科诊断（95%CI下限<10%）。然而，治疗方案准确性等效。使用偏振光皮肤镜检查的远程皮肤病学综合诊断准确性明显优于仅使用宏观图像（P = 0.0017）。添加偏振光皮肤镜检查对恶性病变显示出相同模式，但对良性病变则不然。最有趣的是，对于恶性病变，添加偏振光皮肤镜检查产生了等效的综合诊断准确率。
研究人群缺乏多样性。
使用宏观图像时，远程皮肤病学的诊断准确性低于现场皮肤科诊断，但治疗方案准确性等效。添加偏振光皮肤镜检查可显著提高综合诊断准确性，但治疗方案准确性未得到显著改善。对于重要的恶性病变亚组，添加偏振光皮肤镜检查使远程皮肤科医生和临床皮肤科医生之间的诊断准确性等效。
