Winkelmann Richard R, Tucker Natalie, White Richard, Rigel Darrell S
J Am Osteopath Assoc. 2015 Nov;115(11):666-9. doi: 10.7556/jaoa.2015.137.
The incidence of melanoma has been rising over the past century. With 37% of patients presenting to their primary care physician with at least 1 skin problem, primary care physicians and other nondermatologist practitioners have substantial opportunity to make an impact at the forefront of the disease process. New diagnostic aids have been developed to augment physician analysis of suspicious pigmented skin lesions (PSLs).
To determine the effects of computer-aided multispectral digital skin lesion analysis (MSDSLA) on dermatologists' and nondermatologist clinicians' decisions to biopsy suspicious PSLs after clinical and dermatoscopic evaluation.
Participants were shown 6 images of PSLs. For each PSL, participants were asked 3 times if they would biopsy the lesion: first after reviewing a clinical image of the PSL, again after reviewing a high-resolution dermatoscopic image, and again after reviewing MSDSLA probability findings. An answer was right if a melanoma or high-risk lesion was selected for biopsy or a low-risk lesion was not selected for biopsy. An answer was wrong if a melanoma or high-risk lesion was not selected for biopsy or a low-risk lesion was selected for biopsy. Clinicians' decisions to biopsy were evaluated using χ² analysis for proportions.
Data were analyzed from a total of 212 participants, 177 of whom were dermatologists. Overall, sensitivity of clinical image review was 63%; dermatoscopic image review, 5%; and MSDSLA, 83%. Specificity of clinical image review was 59%; dermatoscopic image review, 40%; and MSDSLA, 76%. Biopsy decision accuracy was 61% after review of clinical images, 52% after review of dermatoscopic images, and 80% after review of MSDSLA findings. The number of lesions participants indicated that they would biopsy increased significantly, from 52% after reviewing clinical images to 63% after reviewing dermatoscopic images (P<.001). However, the overall number of specimens that participants indicated they would biopsy did not change significantly after they reviewed MSDSLA findings (53%).
Sensitivity, specificity, and biopsy decision accuracy increased after clinicians reviewed MSDSLA findings. The use of objective, computer-based diagnostic aids such as MSDSLA during clinical evaluations of ambiguous PSLs could aid clinicians' decisions to biopsy such lesions.
在过去的一个世纪里，黑色素瘤的发病率一直在上升。37%的患者因至少有1种皮肤问题就诊于初级保健医生，初级保健医生和其他非皮肤科医生有很大机会在疾病进程的前沿发挥作用。已开发出新的诊断辅助工具，以增强医生对可疑色素沉着性皮肤病变（PSL）的分析。
确定计算机辅助多光谱数字皮肤病变分析（MSDSLA）对皮肤科医生和非皮肤科临床医生在临床和皮肤镜评估后对可疑PSL进行活检决策的影响。
向参与者展示6张PSL图像。对于每张PSL，询问参与者3次是否会对病变进行活检：第一次是在查看PSL的临床图像后，第二次是在查看高分辨率皮肤镜图像后，第三次是在查看MSDSLA概率结果后。如果选择对黑色素瘤或高风险病变进行活检，或者未选择对低风险病变进行活检，则答案正确。如果未选择对黑色素瘤或高风险病变进行活检，或者选择对低风险病变进行活检，则答案错误。使用χ²分析比例来评估临床医生的活检决策。
共分析了212名参与者的数据，其中177名是皮肤科医生。总体而言，临床图像评估的敏感性为63%；皮肤镜图像评估的敏感性为5%；MSDSLA的敏感性为83%。临床图像评估的特异性为59%；皮肤镜图像评估的特异性为40%；MSDSLA的特异性为76%。查看临床图像后活检决策的准确性为61%，查看皮肤镜图像后为52%，查看MSDSLA结果后为80%。参与者表示会活检的病变数量显著增加，从查看临床图像后的52%增至查看皮肤镜图像后的63%（P<0.001）。然而，参与者表示会活检的标本总数在查看MSDSLA结果后没有显著变化（53%）。
临床医生查看MSDSLA结果后，敏感性、特异性和活检决策准确性均有所提高。在对不明确的PSL进行临床评估时，使用诸如MSDSLA等基于计算机的客观诊断辅助工具可帮助临床医生做出对这类病变进行活检的决策。
