Division of Dermatology, Department of Veterans Affairs Medical Center, Decatur, GA, U.S.A; Department of Dermatology, Emory University, Atlanta, GA, U.S.A.
Br J Dermatol. 2013 Dec;169(6):1219-22. doi: 10.1111/bjd.12591.
Enumerating actinic keratoses (AKs) is highly variable but important to standardize as new therapies are emerging.
To assess the reliability of four different methods used to quantify AKs and to investigate whether a consensus meeting affects the reliability.
This was a single-blinded study of 12 experienced dermatologist raters counting AKs on the face and ears of nine subjects before and after a consensus meeting. Raters were recruited from investigators of a multicentre Veterans Affairs cooperative study. The intraclass correlation coefficient (ICC) among raters for pre- and post-consensus evaluations was the primary outcome measure.
Of the four assessment methods, the 'total count' method had the greatest ICC for both pre- (0·18, P = 0·04) and post-consensus (0·66, P = < 0·0001) assessments. Total count was also the only pre-consensus ICC for which the null hypothesis of no association among assessments was rejected.
Total AK count appears to be the most reliable measure of quantifying AKs on the face and ears. Educational consensus discussion prior to assessment improves reliability of this measure.
日光性角化病（AK）的计数具有高度变异性，但为了标准化，新疗法的出现使其变得重要。
评估四种不同方法定量 AK 的可靠性，并研究共识会议是否会影响可靠性。
这是一项单盲研究，共有 12 名经验丰富的皮肤科评估者在共识会议前后对 9 名受试者的面部和耳部进行 AK 计数。评估者来自一项多中心退伍军人事务合作研究的研究人员。主要观察指标是评估者在共识会议前后评估的组内相关系数（ICC）。
在四种评估方法中，“总数”法在共识会议前后评估中均具有最高的 ICC（分别为 0.18，P = 0.04 和 0.66，P < 0.0001）。总数也是唯一一项评估者之间没有关联的共识会议前 ICC，该 ICC 否定了评估者之间没有关联的零假设。
总 AK 计数似乎是面部和耳部定量 AK 的最可靠方法。评估前的教育共识讨论可提高该测量方法的可靠性。
