Department of Plastic and Reconstructive Surgery, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, United Kingdom.
J Plast Reconstr Aesthet Surg. 2011 Nov;64(11):1460-5. doi: 10.1016/j.bjps.2011.06.017. Epub 2011 Jul 7.
The accuracy of clinical diagnosis of skin lesions has important ramifications for treatment selection and importantly prioritisation for treatment. The objective of this study was to assess the accuracy of diagnosis of skin lesions within our department with an emphasis placed on whether there were any negative consequences of a missed malignant diagnosis. The study was conducted retrospectively. Accuracy of diagnosis was judged on 2 criteria. The first, if the clinical diagnosis matched the histological diagnosis. The second, if the malignancy was diagnosed correctly. 1186 lesions were excised. 57% of patients were female and the mean age was 56 (range 6-94). 25% were invasive malignancies. Clinical diagnosis was correct in 700 (66%) cases. 89% BCCs and 33% of SCCs excised were correctly diagnosed preoperatively. Misdiagnosis of BCCs or SCCs as benign was associated with a stastically significant delay in treatment (BCC 6.2 vs 10.7 weeks, p=0.02) (SCC 3.7 vs 9.5 weeks p=0.004). 100% of correctly diagnosed vs 79% of misdiagnosed SCCs were completely excised. The sensitivity and specificity of the diagnosis of MM were 87% and 97.7% respectively. The mean waiting time for patients correctly diagnosed preoperatively was 2.4 weeks vs 3 weeks (p=0.39). For malignant diagnoses sensitivity was 91%, specificity 84%, PPV 65% and NPV 96%. Misdiagnosis of skin lesions results in delays in treatment and may increase the rate of incomplete excision. The high NPV rate suggests that few malignancies are missed but those that are may have serious consequences if discharged untreated.
皮肤病变的临床诊断准确性对治疗选择具有重要影响，尤其是对治疗的优先级排序具有重要影响。本研究的目的是评估我们科室皮肤病变诊断的准确性，重点关注恶性诊断漏诊是否会产生任何负面影响。该研究是回顾性进行的。诊断准确性根据以下两个标准进行判断。第一个标准是临床诊断是否与组织学诊断相符。第二个标准是恶性肿瘤是否得到正确诊断。共切除了 1186 个病变。700 例（66%）患者的临床诊断是正确的。患者中女性占 57%，平均年龄为 56 岁（范围 6-94 岁）。25%的患者为侵袭性恶性肿瘤。89%的 BCC 和 33%的 SCC 在术前得到了正确诊断。BCC 或 SCC 误诊为良性与治疗时间显著延迟相关（BCC 为 6.2 周 vs 10.7 周，p=0.02）（SCC 为 3.7 周 vs 9.5 周，p=0.004）。100%正确诊断的 SCC 与 79%误诊的 SCC 均完全切除。MM 的诊断敏感度和特异性分别为 87%和 97.7%。术前正确诊断的患者平均等待时间为 2.4 周 vs 3 周（p=0.39）。恶性诊断的敏感度为 91%，特异性为 84%，阳性预测值为 65%，阴性预测值为 96%。皮肤病变的误诊会导致治疗延误，并可能增加不完全切除的发生率。高阴性预测值表明很少会漏诊恶性肿瘤，但如果未及时治疗，可能会导致严重后果。
