Hoogedoorn L, Gerritsen M J P, Wolberink E A W, Peppelman M, van de Kerkhof P C M, van Erp P E J
Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Eur Acad Dermatol Venereol. 2016 Aug;30(8):1308-14. doi: 10.1111/jdv.13627. Epub 2016 Apr 2.
Reflectance confocal microscopy (RCM) is gradually implemented in dermatology. Strategies for further implementation and practical 'hands on' guidelines are lacking.
The primary outcome was to conduct a general strategy for further implementation of RCM. The secondary outcome was the diagnosis of psoriasis and differentiation of stable from unstable psoriatic plaques by means of the 'hands on' protocol, derived from the strategy.
We used a four-phased model; an exploring phase, a systematic literature search, a clinical approach and, finally, an integration phase to develop a clinical guideline for RCM in psoriasis. Receiver operating characteristic curve statistics was applied to define the accuracy for the diagnosis of unstable psoriasis.
A general strategy for further implementation of RCM and practical approach was developed to examine psoriasis by RCM and to distinguish stable from unstable psoriasis. Unstable psoriasis was diagnosed by epidermal inflammatory cell counts with a sensitivity and specificity of 91.7% and 98.3%, respectively, and with an accuracy of 0.92 (area under the curve). In addition, a monitoring model was proposed.
This is the first study that shows a method for implementation of RCM in dermatology. The strategy and hands on protocol for psoriasis may serve as a model for other dermatological entities and additionally may lead to specialized ready-to-use RCM protocols for clinical dermatological practice.
反射式共聚焦显微镜（RCM）在皮肤科的应用正逐渐普及。目前缺乏进一步推广应用的策略以及实用的“实操”指南。
主要结果是制定RCM进一步推广应用的总体策略。次要结果是通过源自该策略的“实操”方案诊断银屑病，并区分稳定期和不稳定期银屑病斑块。
我们采用了一个四阶段模型，即探索阶段、系统文献检索、临床方法，最后是整合阶段，以制定银屑病RCM临床指南。应用受试者操作特征曲线统计来确定不稳定型银屑病诊断的准确性。
制定了RCM进一步推广应用的总体策略和实用方法，用于通过RCM检查银屑病并区分稳定期和不稳定期银屑病。通过表皮炎症细胞计数诊断不稳定型银屑病，敏感性和特异性分别为91.7%和98.3%，曲线下面积的准确性为0.92。此外，还提出了一个监测模型。
这是第一项展示在皮肤科实施RCM方法的研究。银屑病的策略和实操方案可作为其他皮肤病实体的模型，此外还可能产生适用于临床皮肤科实践的专用即用型RCM方案。
