Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
JAMA Dermatol. 2016 Oct 1;152(10):1093-1098. doi: 10.1001/jamadermatol.2016.1188.
Reflectance confocal microscopy (RCM) improves diagnostic accuracy in skin cancer detection when combined with dermoscopy; however, little evidence has been gathered regarding its real impact on routine clinical workflow, and, to our knowledge, no studies have defined the terms for its optimal application.
To identify lesions on which RCM performs better in terms of diagnostic accuracy and consequently to outline the best indications for use of RCM.
DESIGN, SETTING, AND PARTICIPANTS: Prospectively acquired and evaluated RCM images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal skin lesion referred to RCM imaging, from January 2012 to October 2014, carried out in a tertiary referral academic center.
A total of 1279 equivocal skin lesions were sent for RCM imaging. Spearman correlation, univariate, and multivariate regression models were performed to find features significantly correlated with RCM outcome.
In a total of 1279 lesions in 1147 patients, RCM sensitivity and specificity were 95.3% and 83.9%, respectively. The number of lesions needed to excise to rule out a melanoma was 2.4. After univariate and multivariate regression analysis, head and neck resulted as the most appropriate body location for confocal examination; RCM showed a high diagnostic accuracy for lesions located on sun-damaged skin (adjusted odds ratio [aOR], 2.13; 95% CI, 1.37-3.30; P=.001) and typified by dermoscopic regression (aOR, 2.13; 95% CI, 1.31-3.47; P=.002) or basal-cell carcinoma specific criteria (aOR, 9.35; 95% CI, 1.28-68.58; P=.03).
Lesions located on the head and neck, damaged by chronic sun-exposure, and dermoscopically typified by regression represent best indications for the use of RCM.
共聚焦激光显微镜（RCM）结合皮肤镜可提高皮肤癌诊断的准确性；然而，有关其对常规临床工作流程实际影响的证据很少，据我们所知，尚无研究定义其最佳应用术语。
确定 RCM 在诊断准确性方面表现更好的病变，并据此确定 RCM 的最佳应用指征。
设计、设置和参与者：前瞻性采集 2012 年 1 月至 2014 年 10 月在一家三级转诊学术中心接受 RCM 成像的至少 1 例临床和/或皮肤镜表现为可疑的连续患者的 RCM 图像，进行评估。
共发送了 1279 例可疑皮肤病变进行 RCM 成像。采用 Spearman 相关分析、单变量和多变量回归模型来寻找与 RCM 结果显著相关的特征。
在 1147 例患者的 1279 例病变中，RCM 的敏感性和特异性分别为 95.3%和 83.9%。排除黑素瘤所需切除的病变数为 2.4。经过单变量和多变量回归分析，头颈部是进行共焦检查的最合适身体部位；RCM 对头颈部位于日光损伤皮肤的病变（调整比值比[aOR]，2.13；95%CI，1.37-3.30；P=.001）和表现为皮肤镜下退化（aOR，2.13；95%CI，1.31-3.47；P=.002）或基底细胞癌特异性标准（aOR，9.35；95%CI，1.28-68.58；P=.03）的病变具有较高的诊断准确性。
位于头颈部、因慢性阳光暴露受损且皮肤镜下表现为退化的病变是使用 RCM 的最佳指征。
