Biyik Ozkaya Dilek, Onsun Nahide, Su Ozlem, Arda Ulusal Hande, Pirmit Serpil
Assist. Prof. Dilek Biyik Ozakaya, MD, Bezmialem University, Medical Faculty, Dermatovenerology Department, Adnan Menderes Bulvari Vatan Cad. 34093 , Fatih/Istanbul, Turkey;
Acta Dermatovenerol Croat. 2014;22(4):278-83.
Dermoscopy plays an important role in the diagnosis of pigmented lesions, particularly in the differential diagnosis of early-stage melanoma. Dermoscopy systems that aim to enable automatic "unmanned-without physician" diagnosis are becoming increasingly common. We aimed to investigate the reliability and weaknesses of diagnosis programs. Furthermore, we attempted to determine whether such programs are superior to diagnosis by a physician, compared to histopathological assessment. The images stored in the DermoGenius ultra-computerized dermoscopy system of the Dermoscopy Unit between January 2008 and December 2008 were surveyed retrospectively. Dermoscopic images made prior to excision of 77 lesions from 51 patients verified by histopathology were reviewed. Nineteen patients were men and 32 were women. Mean age was 35.5 years. Diagnosis by a clinician or automatic analysis revealed that 23 (30%) of the lesions were atypical (dysplastic) nevi, 22 (29%) were compound nevi, 10 (13%) were dermal nevi, 8 (10%) were malignant melanomas, 7 (9%) were common nevi, 6 (7%) were junctional nevi, and 1 (1%) was a blue nevus. Compared to histopathological diagnosis, considered the gold standard, the sensitivity of the automated analysis program was 96.6%, its specificity 14.9%, and its diagnostic accuracy 47%. For the clinician, the values were 100% for sensitivity, 66.7% for specificity, and 95% for diagnostic accuracy. Based on histopathological results, the diagnostic accuracy of the physician was higher than that of the automatic analysis program. Therefore, errors are inevitable when an inexperienced physician assesses patients according to automatic program results.
皮肤镜检查在色素性皮损的诊断中发挥着重要作用，尤其是在早期黑色素瘤的鉴别诊断方面。旨在实现自动“无人——无需医生”诊断的皮肤镜检查系统正变得越来越普遍。我们旨在研究诊断程序的可靠性和不足之处。此外，我们试图确定与组织病理学评估相比，此类程序是否优于医生的诊断。回顾性调查了2008年1月至2008年12月期间皮肤镜检查科DermoGenius超计算机化皮肤镜系统中存储的图像。对51例患者77处经组织病理学证实的皮损切除前的皮肤镜图像进行了回顾。19例为男性，32例为女性。平均年龄为35.5岁。临床医生诊断或自动分析显示，23处（30%）皮损为非典型（发育异常）痣，22处（29%）为复合痣，10处（13%）为皮内痣，8处（10%）为恶性黑色素瘤，7处（9%）为普通痣，6处（7%）为交界痣，1处（1%）为蓝痣。与被视为金标准的组织病理学诊断相比，自动分析程序的敏感性为96.6%，特异性为14.9%，诊断准确性为47%。对于临床医生而言，敏感性值为100%，特异性值为66.7%，诊断准确性值为95%。基于组织病理学结果，医生的诊断准确性高于自动分析程序。因此，经验不足的医生根据自动程序结果评估患者时，错误是不可避免的。
