Department of Dermatology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey.
Indian J Dermatol Venereol Leprol. 2010 Mar-Apr;76(2):132-7. doi: 10.4103/0378-6323.60550.
In a dermoscopic examination, besides structural components, inexperienced clinicians should also be able to recognize the gross features of the images.
The aim of this study is, whether or not an inexperienced clinician has problems in the recognition of gross features of the images on dermoscopic examination.
Two dermatologists, of whom one was experienced in the field of dermoscopy and the other was not, examined 161 dermoscopic images of melanocytic lesions in the gross features of their borders. Inner and outer borders were defined for each lesion. Both dermatologists separately evaluated the borders of the lesions for irregularity, asymmetry, and wideness of fading. For subjective image analysis they scored each lesion by using the four-point ordinal scale. For computerized image analysis they manually marked borders with dots, by using a computer program. We used quadratic-weighted kappa for interobserver reliability assessments for subjective scores and intraclass correlation coefficients (ICC) for automatically calculated scores.
In a subjective evaluation the inexperienced observer used a higher score than the experienced observer and the kappa values were between 0.241-0.286. ICC for the automatically calculated scores were between 0.357 and 0.522. According to both the outer and the inner borders, the concordance between experienced and inexperienced observers was almost perfect in measurements of diameter, perimeter, and area (ICC scores were between 0.948 and 0.990).
An inexperienced person, in comparison with an experienced person, sees lesions in the same sizes, but in different shapes on dermoscopy. Therefore, it is advisable that making learners familiar with the borders of lesions should be included in the training on dermoscopy.
在皮肤镜检查中，除了结构成分外，经验不足的临床医生还应该能够识别图像的大体特征。
本研究旨在探讨经验不足的临床医生在皮肤镜检查中识别图像大体特征方面是否存在问题。
两位皮肤科医生，其中一位在皮肤镜领域有经验，另一位没有，检查了 161 张黑素细胞病变的皮肤镜图像的大体特征。为每个病变定义了内边界和外边界。两位皮肤科医生分别评估了病变边界的不规则性、不对称性和褪色宽度。对于主观图像分析，他们使用四点有序量表对每个病变进行评分。对于计算机化图像分析，他们使用计算机程序手动用点标记边界。我们使用二次加权 kappa 评估主观评分的观察者间可靠性，使用组内相关系数（ICC）评估自动计算评分的观察者间可靠性。
在主观评估中，经验不足的观察者使用的评分高于经验丰富的观察者，kappa 值在 0.241-0.286 之间。自动计算评分的 ICC 值在 0.357 和 0.522 之间。根据外边界和内边界，经验丰富和经验不足的观察者在直径、周长和面积的测量方面具有几乎完美的一致性（ICC 评分在 0.948 和 0.990 之间）。
与经验丰富的人相比，经验不足的人在皮肤镜下看到的病变大小相同，但形状不同。因此，建议在皮肤镜培训中应包括让学习者熟悉病变边界的内容。
