Dermatoepidemiology Unit, VA Medical Center, Providence, RI, U.S.A; Department of Dermatology, Brown University, Providence, RI, U.S.A.
Br J Dermatol. 2014 Jan;170(1):188-91. doi: 10.1111/bjd.12629.
Actinic keratoses (AKs) often serve as a primary endpoint for clinical studies. However, reliability of counting these lesions is poor, even among expert dermatologists.
To investigate the reliability of counting AKs before and after a yearly consensus meeting, held annually for 4 years.
As part of the Veterans Affairs (VA) Keratinocyte Carcinoma Chemoprevention Trial, board-certified dermatologists convened annually for 4 years to individually count the number of actinic keratoses on three to five test subjects. The dermatologists then met as a group for a consensus discussion on what constituted an AK lesion on each subject. Afterwards, each dermatologist repeated the independent counting exercise on three to five new subjects. The intraclass correlation coefficient (ICC) was used to analyze the reliability of counting AKs among the dermatologists.
Eight dermatologists participated in this exercise for 4 consecutive years. Pre-consensus discussion ICCs over 4 years were 0.18, 0.34, 0.38, 0.75, respectively, showing sustained improvement with each consensus discussion. The greatest improvement in reliability of AK counts was shown during the first year of consensus discussions, when the ICC improved from 0.18 to 0.67. There was no improvement by the fourth year of consensus discussion, with pre- and post-consensus ICCs of 0.75 and 0.75, respectively.
Annual consensus discussions can lead to improvement in reliability of AK counts. This improvement was sustained over 4 years. By the fourth year, the discussion meeting had no effect on improvement in reliability. A consensus meeting discussion may be helpful for improving reliability in other trials.
光化性角化病（AK）通常作为临床研究的主要终点。然而，即使是经验丰富的皮肤科医生，对这些病变的计数也不可靠。
研究每年举行一次共识会议前后对 AK 计数的可靠性，该会议连续举行了 4 年。
作为退伍军人事务部（VA）角质细胞癌化学预防试验的一部分，经过认证的皮肤科医生每年聚会 4 次，对 3 到 5 名测试对象的 AK 数量进行单独计数。然后，皮肤科医生作为一个小组开会，就每个测试对象的 AK 病变达成共识。之后，每位皮肤科医生对 3 到 5 名新的测试对象重复独立计数练习。使用组内相关系数（ICC）分析皮肤科医生计数 AK 的可靠性。
8 位皮肤科医生连续 4 年参加了这项研究。共识讨论前的 ICC 在 4 年内分别为 0.18、0.34、0.38、0.75，表明每次共识讨论都有持续改善。在共识讨论的第一年，AK 计数的可靠性提高最为显著，ICC 从 0.18 提高到 0.67。在共识讨论的第四年，没有进一步的改善，共识前和共识后的 ICC 分别为 0.75 和 0.75。
每年的共识讨论可以提高 AK 计数的可靠性。这种改善在 4 年内持续存在。到第四年，讨论会议对提高可靠性没有影响。共识会议讨论可能有助于提高其他试验的可靠性。
