Haspeslagh Marc, Hoorens Isabelle, Degryse Nele, De Wispelaere Ine, Degroote Annemarie, Van Belle Sarah, Verboven Jan, Vossaert Katrien, Facchetti Fabio, Van Dorpe Jo, De Schepper Sofie, Brochez Lieve
Dermpat, Ghent, Belgium2Department of Dermatology, Ghent University Hospital, Belgium.
Department of Dermatology, Ghent University Hospital, Belgium.
JAMA Dermatol. 2017 Feb 1;153(2):154-161. doi: 10.1001/jamadermatol.2016.4444.
Ex vivo dermoscopy (EVD) with derm dotting (DD) improves clinicopathologic correlation and the quality of diagnosis in skin tumors.
To compare the diagnostic performance of the standard method of skin biopsy processing with the practice of EVD with DD.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study compares the diagnostic performance in 6526 skin biopsy specimens examined from 2008 to 2010 with a standard method of processing with 8584 biopsy specimens examined in 2015 with EVD and DD. Data were analyzed from January 1 to March 31, 2016. A total of 15 110 skin biopsy specimens were included. The biopsy specimens from 2008 to 2010 were processed in a hospital-based general pathology laboratory; the biopsy specimens from 2015 were processed in a private dermatopathology laboratory. Biopsy specimens from both periods were diagnosed by the same dermatopathologist.
The primary outcome measures were clinicopathological characteristics, usefulness of EVD with DD, and turnaround times (TATs).
Use of EVD with DD increased the detection of positive section margins in nonmelanoma skin cancer from 8.4% to 12.8%. The most significant increase was seen in Bowen disease, invasive squamous cell carcinoma, and a superficial type of basal cell carcinoma (BCC). With EVD and DD, a specific clinicopathologic diagnosis was made in 27.7% of nevi compared with only 10.3% using the standard method. The incidence of moderately and severely dysplastic nevi increased from 1.0% to 7.2% and from 0.6% to 1.4%, respectively. The detection of ulceration in melanomas with thicker than 1 mm increased from 24.0% to 31.3%. The number of nevi-associated melanomas increased from 15.5% to 33.3%. The number of collision lesions from 0.07% to 1.07%. The TAT for nevi decreased from 2 days to 1 day, for melanomas from 5 days to 2 days, and for BCC from 2 days to 1 day.
Ex vivo dermoscopy and DD with adapted sectioning in a dermatopathology setting allows a more accurate and less time consuming histopathologic diagnosis of skin tumors. These findings suggest that pathologists involved in skin tumor evaluation should be encouraged to learn dermoscopy and replace random transverse cutting with lesion-specific and DD-guided cutting.
采用真皮点涂法的离体皮肤镜检查（EVD）可改善皮肤肿瘤的临床病理相关性及诊断质量。
比较皮肤活检标准处理方法与采用真皮点涂法的离体皮肤镜检查的诊断性能。
设计、地点和参与者：这项回顾性研究比较了2008年至2010年采用标准处理方法检查的6526份皮肤活检标本与2015年采用离体皮肤镜检查和真皮点涂法检查的8584份活检标本的诊断性能。对2016年1月1日至3月31日的数据进行分析。共纳入15110份皮肤活检标本。2008年至2010年的活检标本在一家医院的普通病理实验室处理；2015年的活检标本在一家私立皮肤病理实验室处理。两个时期的活检标本均由同一位皮肤病理学家诊断。
主要结局指标为临床病理特征、采用真皮点涂法的离体皮肤镜检查的实用性及周转时间（TAT）。
采用真皮点涂法的离体皮肤镜检查使非黑素瘤皮肤癌切缘阳性的检出率从8.4%提高至12.8%。在鲍温病、浸润性鳞状细胞癌和浅表型基底细胞癌（BCC）中增幅最为显著。采用离体皮肤镜检查和真皮点涂法，27.7%的痣可做出特异性临床病理诊断，而采用标准方法仅为10.3%。中度和重度发育异常痣的发生率分别从1.0%增至7.2%和从0.6%增至1.4%。厚度超过1 mm的黑色素瘤溃疡检出率从24.0%增至31.3%。痣相关黑色素瘤的数量从15.5%增至33.3%。碰撞性病变的数量从0.07%增至1.07%。痣的周转时间从2天降至1天，黑色素瘤从5天降至2天，基底细胞癌从2天降至1天。
在皮肤病理环境中采用离体皮肤镜检查和真皮点涂法并配合适当切片，可实现对皮肤肿瘤更准确且耗时更短的组织病理学诊断。这些发现表明，应鼓励参与皮肤肿瘤评估的病理学家学习皮肤镜检查，并以病变特异性和真皮点涂法引导的切片取代随机横向切片。
