移动远程皮肤病学在皮肤癌筛查中的应用。

Application of mobile teledermatology for skin cancer screening.

机构信息

Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California 95816, USA.

出版信息

J Am Acad Dermatol. 2012 Oct;67(4):576-81. doi: 10.1016/j.jaad.2011.11.957. Epub 2012 Jan 13.

DOI:10.1016/j.jaad.2011.11.957

PMID:22243769

Abstract

BACKGROUND

With advancements in mobile technology, cellular phone-based store-and-forward teledermatology may be applied to skin cancer screening.

OBJECTIVE

We sought to determine diagnostic and management concordance between in-person and teledermatology evaluations for patients at skin cancer screening whose clinical images and history were transmitted through mobile phones.

METHODS

A total of 86 patients with 137 skin lesions presented to a skin cancer screening event in California. These patients' clinical history and skin images were captured by a software-enabled mobile phone. Patients were assessed separately by an in-person dermatologist and a teledermatologist, who evaluated the mobile phone-transmitted history and images. Diagnostic and management concordance was determined between the in-person and teledermatology evaluations.

RESULTS

The primary categorical diagnostic concordance was 82% between the in-person dermatologist and the teledermatologist (95% confidence interval 0.73-0.89), with a Kappa coefficient of 0.62 indicating good agreement. The aggregated diagnostic concordance between the in-person dermatologist and the teledermatologist was 62% (95% confidence interval 0.51-0.71), with Kappa coefficient of 0.60 indicating good agreement. Management concordance between the in-person dermatologist and the teledermatologist was 81% (95% confidence interval 0.72-0.88), with a Kappa coefficient of 0.57, which indicates moderate agreement between the dermatologists. Multivariate analysis showed that older age and presentation of atypical nevus were significantly associated with disagreement in diagnosis between the teledermatologist and in-person dermatologist, after adjusting for other factors.

LIMITATIONS

Dermatoscopic images were not captured via mobile phones, which might improve diagnostic accuracy.

CONCLUSION

Mobile teledermatology using cellular phones is an innovative and convenient modality of providing dermatologic consultations for skin cancer screening.

摘要

背景

随着移动技术的进步，基于手机的存储转发远程皮肤病学可能应用于皮肤癌筛查。

目的

我们旨在确定通过手机传输临床图像和病史的皮肤癌筛查患者的面对面和远程皮肤病学评估之间的诊断和管理一致性。

方法

共有 86 名患有 137 处皮肤病变的患者参加了加利福尼亚州的皮肤癌筛查活动。这些患者的临床病史和皮肤图像由软件支持的移动电话捕获。由一名面对面的皮肤科医生和一名远程皮肤科医生分别对患者进行评估，他们评估了通过手机传输的病史和图像。确定了面对面和远程皮肤病学评估之间的诊断和管理一致性。

结果

面对面的皮肤科医生和远程皮肤科医生之间的主要分类诊断一致性为 82%（95%置信区间 0.73-0.89），Kappa 系数为 0.62，表明一致性良好。面对面的皮肤科医生和远程皮肤科医生之间的总体诊断一致性为 62%（95%置信区间 0.51-0.71），Kappa 系数为 0.60，表明一致性良好。面对面的皮肤科医生和远程皮肤科医生之间的管理一致性为 81%（95%置信区间 0.72-0.88），Kappa 系数为 0.57，表明两位皮肤科医生之间存在中度一致性。多变量分析表明，在调整其他因素后，年龄较大和表现为非典型痣与远程皮肤科医生和面对面皮肤科医生之间的诊断分歧显著相关。