Edwards S J, Osei-Assibey G, Patalay R, Wakefield V, Karner C
BMJ Technology Assessment Group, BMJ, London, UK.
Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Clin Exp Dermatol. 2017 Apr;42(3):266-275. doi: 10.1111/ced.13055. Epub 2017 Feb 20.
Skin cancer is one of the most common cancers in the UK. Patients with suspicious skin lesions are assessed clinically with/without dermoscopy, and lesions still considered suspicious are then surgically removed or have the diagnosis confirmed by a punch biopsy.
To evaluate the diagnostic accuracy of the in vivo VivaScope reflective confocal microscopy (RCM) system, a noninvasive technology designed to provide a more accurate presurgical diagnosis, leading to fewer biopsies of benign lesions, or to provide greater accuracy for lesion margins.
MEDLINE, EMBASE and the Cochrane Library were searched to identify studies evaluating dermoscopy plus RCM, or RCM alone, with histopathology as the reference test. Clinical experts were also contacted for information on unpublished studies.
Eleven studies met the inclusion criteria but were too heterogeneous to be combined by meta-analysis. Results indicated that VivaScope subsequent to dermoscopy may improve diagnostic accuracy of malignant melanomas compared with dermoscopy. For margin delineation, the data suggest that mapping using VivaScope 1500 for lentigo maligna (LM) and LM melanoma may improve accuracy in terms of complete excision of lesions compared with dermoscopically determined margins. For basal cell carcinoma, the limited data show high diagnostic accuracy with both VivaScope 1500 and VivaScope 3000. Evidence on the effectiveness of VivaScope in diagnosing cutaneous squamous cell carcinomas was very limited.
The use of VivaScope 1500 following dermoscopy may improve patient care and management of suspicious skin lesions, although the generalizability of these results to the UK population remains unclear.
皮肤癌是英国最常见的癌症之一。临床会对有可疑皮肤病变的患者进行评估，评估方式包括使用或不使用皮肤镜，对于仍被认为可疑的病变，会进行手术切除或通过穿刺活检来确诊。
评估体内VivaScope反射式共聚焦显微镜（RCM）系统的诊断准确性，这是一种非侵入性技术，旨在提供更准确的术前诊断，减少对良性病变的活检次数，或提高病变边缘的准确性。
检索MEDLINE、EMBASE和Cochrane图书馆，以识别评估皮肤镜联合RCM或单独使用RCM并以组织病理学作为参考测试的研究。还联系了临床专家以获取未发表研究的信息。
11项研究符合纳入标准，但异质性太大，无法通过荟萃分析进行合并。结果表明，与皮肤镜相比，在皮肤镜检查后使用VivaScope可能会提高恶性黑色素瘤的诊断准确性。对于边缘划定，数据表明，与皮肤镜确定的边缘相比，使用VivaScope 1500对恶性雀斑样痣（LM）和LM黑色素瘤进行映射可能会提高病变完全切除的准确性。对于基底细胞癌，有限的数据显示VivaScope 1500和VivaScope 3000的诊断准确性都很高。关于VivaScope在诊断皮肤鳞状细胞癌方面有效性的证据非常有限。
皮肤镜检查后使用VivaScope 1500可能会改善对可疑皮肤病变的患者护理和管理，尽管这些结果对英国人群的普遍性仍不明确。
