Tandjung Ryan, Badertscher Nina, Kleiner Nadine, Wensing Michel, Rosemann Thomas, Braun Ralph P, Senn Oliver
Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
J Eval Clin Pract. 2015 Apr;21(2):326-31. doi: 10.1111/jep.12323. Epub 2015 Feb 2.
RATIONALE, AIM AND OBJECTIVE: To test feasibility and diagnostic accuracy of dermatologist's feedback based on digital images of skin lesions collected in Swiss primary care.
This was a process analysis of a randomized controlled trial, conducted in 2011/2012. 30 of 78 general practitioners (GPs) were randomized to an intervention, which included dermatologist's feedback on digital images of skin lesions. Feedback was categorized into four categories: (1) no further investigation; (2) clinical observation; (3) biopsy; and (4) other. Histologic findings were allocated to the same categories. Feasibility was measured in the perspective of GPs concerning technical handling and of dermatologists as proportion of images usable for feedback. Diagnostic accuracy was measured as proportion of malignant histology of the first three feedback groups. No long-term data was collected.
981 images of skin lesions were collected, two were not eligible due to low quality of images. The majority of GPs (77.8%) reported no problem with the procedure. 207 images were in feedback category 1, 353 in 2, 360 in 3 and 59 in 4. A total of 236 histologic tests were collected. Three cases in category 1 indicated malignancy (1 melanoma). 201 of category 3 received a biopsy, where in 91 (45.3%) malignancy was confirmed.
Teledermatology with digital images taken in primary care was feasible from a GP and from a specialist perspective. However, diagnostic appropriateness regarding avoidance of specialist care and possible missed skin cancer raises concerns. These results therefore question a promotion of teledermatology in clinical routine.
原理、目的和目标：基于瑞士初级保健中收集的皮肤病变数字图像，测试皮肤科医生反馈的可行性和诊断准确性。
这是一项对2011/2012年进行的随机对照试验的过程分析。78名全科医生（GP）中的30名被随机分配到一项干预措施中，该措施包括皮肤科医生对皮肤病变数字图像的反馈。反馈分为四类：（1）无需进一步检查；（2）临床观察；（3）活检；（4）其他。组织学结果也被归入相同类别。从全科医生对技术操作的角度以及皮肤科医生对可用于反馈的图像比例的角度来衡量可行性。诊断准确性以前三类反馈中恶性组织学的比例来衡量。未收集长期数据。
共收集了981张皮肤病变图像，其中两张因图像质量低而不符合要求。大多数全科医生（77.8%）表示该程序没有问题。207张图像属于反馈类别1，353张属于类别2，360张属于类别3，59张属于类别4。共收集了236份组织学检查报告。类别1中有3例显示为恶性（1例黑色素瘤）。类别3中有201例接受了活检，其中91例（45.3%）被确诊为恶性。
从全科医生和专科医生的角度来看，在初级保健中使用数字图像进行远程皮肤病学是可行的。然而，在避免专科护理和可能漏诊皮肤癌方面的诊断适当性令人担忧。因此，这些结果对在临床常规中推广远程皮肤病学提出了质疑。
