Winkelmann Richard R, Yoo Jane, Tucker Natalie, White Richard, Rigel Darrell S
Melanoma Clinical Research Fellow, Rigel Dermatology, New York, New York.
Mohs Surgery Fellow, Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
J Clin Aesthet Dermatol. 2015 Sep;8(9):21-4.
To determine how a multispectral digital skin lesion analysis (MSDSLA) device data affects the biopsy performance of dermatologists and non-dermatologist practitioners following clinical and dermoscopic pigmented lesion evaluation.
MSDSLA employs near infrared light to image and analyze pigmented skin lesions. MSDSLA generates a "classifier score" based on morphological disorganization. Using a logistical regression model, 1) a probability of being melanoma and, 2) a probability of being melanoma, atypical melanocytic hyperplasia, or a high grade dysplastic nevus is computed. PARTICIPANTS were shown clinical images of 12 lesions (2 melanomas in situ, 3 invasive melanomas, and 7 low grade DNs). They were asked first if they would biopsy the lesion based on clinical images, again after observing dermoscopy images, and once more when presented with MSDSLA probability information.
National dermoscopy conference.
Sixty-four healthcare providers; 30 dermatologists and 34 non-dermatologist practitioners.
Sensitivity, specificity, diagnostic accuracy, biopsy rates Results: For the 30 dermatologists, sensitivity was 65 percent after clinical evaluation (C) and 65% post-dermoscopy (D) but improved to 91% after MSDSLA. For the 34 non-dermatologist practitioners, sensitivity improved from 66 percent (C) to 70 percent (D) to 95 percent after MSDSLA. With MSDSLA information, dermatologist specificity increased from 40 percent (D) to 58 percent while non-dermatologist practitioners specificity increased from 34 percent (D) to 55 percent. Diagnostic accuracy of malignant and benign lesions decreased for both groups 55 percent (C) to 51 percent (D) for dermatologists and 54 percent (C) to 49 percent (D) for non-dermatologist practitioners. However, diagnostic accuracy increased to 72 percent for dermatologists and 72 percent for non-dermatologist practitioners with MSDSLA data. Non-melanoma biopsy percentages by dermatologists increased from 53 percent (C) to 60 percent (D), but decreased to 42 percent when provided with MSDSLA data. Similarly, non-dermatologist practitioners' biopsy percentages of nonmelanomas increased from 55 percent (C) to 66 percent (D) and decreased to 45 percent with MSDSLA.
Decisions to biopsy atypical melanocytic lesions were more sensitive and specific when MSDSLA information was provided for both dermatologists and nondermatologist practitioners. Both groups were also less likely to biopsy nonmelanomas after MSDSLA evaluation. The authors' results suggest providing practitioners with MSDSLA data leads to improved biopsy accuracy decreasing the number of nonessential biopsies for nonmelanocytic lesions even after dermoscopic evaluation.
确定多光谱数字皮肤病变分析（MSDSLA）设备数据在临床和皮肤镜检查色素性病变评估后，对皮肤科医生和非皮肤科医生活检操作的影响。
MSDSLA利用近红外光对色素性皮肤病变进行成像和分析。MSDSLA根据形态紊乱生成一个“分类器分数”。使用逻辑回归模型，计算1）患黑色素瘤的概率，以及2）患黑色素瘤、非典型黑素细胞增生或高级别发育异常痣的概率。向参与者展示12个病变的临床图像（2例原位黑色素瘤、3例侵袭性黑色素瘤和7例低级别发育异常痣）。首先询问他们是否会基于临床图像对病变进行活检，在观察皮肤镜图像后再次询问，以及在提供MSDSLA概率信息时再次询问。
全国皮肤镜检查会议。
64名医疗服务提供者；30名皮肤科医生和34名非皮肤科医生。
敏感性、特异性、诊断准确性、活检率 结果：对于30名皮肤科医生，临床评估（C）后的敏感性为65%，皮肤镜检查（D）后为65%，但在MSDSLA后提高到91%。对于34名非皮肤科医生，敏感性从66%（C）提高到70%（D），在MSDSLA后提高到95%。有了MSDSLA信息，皮肤科医生的特异性从40%（D）提高到58%，而非皮肤科医生的特异性从34%（D）提高到55%。两组对恶性和良性病变的诊断准确性均下降，皮肤科医生从55%（C）降至51%（D），非皮肤科医生从54%（C）降至49%（D）。然而，有了MSDSLA数据后，皮肤科医生和非皮肤科医生的诊断准确性均提高到72%。皮肤科医生对非黑色素瘤的活检百分比从53%（C）提高到60%（D），但在提供MSDSLA数据时降至42%。同样，非皮肤科医生对非黑色素瘤的活检百分比从55%（C）提高到66%（D），在MSDSLA时降至45%。
当为皮肤科医生和非皮肤科医生提供MSDSLA信息时，对非典型黑素细胞病变进行活检的决策更具敏感性和特异性。两组在MSDSLA评估后对非黑色素瘤进行活检的可能性也较小。作者的结果表明，为从业者提供MSDSLA数据可提高活检准确性，减少非黑色素细胞病变不必要的活检数量，即使在皮肤镜检查评估之后。
