不同形态闪亮白色条纹对黑色素瘤的诊断价值及组织学相关性：一项回顾性病例对照研究。
The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: A retrospective, case-control study.
机构信息
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppage, New York, New York.
出版信息
J Am Acad Dermatol. 2018 May;78(5):913-919. doi: 10.1016/j.jaad.2017.11.021. Epub 2017 Nov 11.
BACKGROUND
Shiny white streaks (SWSs) are best visualized with polarized dermoscopy and correlate with dermal fibroplasia histopathologically. SWSs have been described at higher frequencies in melanomas than in benign nevi.
OBJECTIVE
We assessed the diagnostic value of different patterns of SWSs and their histologic correlate in melanocytic lesions.
METHODS
Polarized dermoscopic images of 1507 histopathologically diagnosed melanocytic neoplasms were analyzed for presence and pattern of SWSs. Histology was also reviewed for correlation.
RESULTS
Among 1507 melanocytic neoplasms, SWSs were observed in 31 of 144 melanomas (22%) and 22 of 1363 benign neoplasms (1.6%) (P < .001). The sensitivity and specificity of SWSs for melanoma were 22% and 98%, respectively. Diffuse SWSs exhibited the greatest diagnostic value for melanoma, with sensitivity of 11.8% and specificity of 99.5%. Focal central and peripheral SWSs were comparable in diagnostic significance. The presence of SWSs was highly uncommon in dysplastic nevi, whereas in certain benign subgroups of nevi such as Spitz nevi and atypical genital special site nevi, SWSs were not uncommon. Diffuse SWSs correlated with greater breadth of deep fibroplasia than focal SWSs (P = .009), and SWSs correlated with greater Breslow depth among melanomas (P = .007).
LIMITATIONS
This study was retrospective.
CONCLUSION
Polarized dermoscopy is a valuable diagnostic tool in the identification of SWSs, a feature that is highly specific for melanoma.
背景
闪亮的白色条纹（SWSs）在偏振皮肤镜下最易观察，且与组织病理学上的真皮纤维增生相关。SWSs 在黑色素瘤中的描述频率高于良性痣。
目的
我们评估了不同模式的 SWSs 及其在黑色素细胞病变中的组织学相关性的诊断价值。
方法
对 1507 例经组织病理学诊断的黑色素细胞肿瘤的偏振皮肤镜图像进行分析，以评估 SWSs 的存在和模式。同时也回顾了组织学相关性。
结果
在 1507 例黑色素细胞肿瘤中，144 例黑色素瘤中有 31 例（22%）和 1363 例良性肿瘤中有 22 例（1.6%）观察到 SWSs（P<.001）。SWSs 对黑色素瘤的敏感性和特异性分别为 22%和 98%。弥漫性 SWSs 对黑色素瘤的诊断价值最大，敏感性为 11.8%，特异性为 99.5%。局灶性中央和外周 SWSs 的诊断意义相当。发育不良痣中 SWSs 的存在极为罕见，而在某些良性痣亚组（如 Spitz 痣和非典型生殖器特殊部位痣）中，SWSs 并不罕见。弥漫性 SWSs 与更广泛的深层纤维增生相关（P=.009），且 SWSs 与黑色素瘤中的 Breslow 深度增加相关（P=.007）。
局限性
本研究为回顾性研究。
结论
偏振皮肤镜是识别 SWSs 的一种有价值的诊断工具，这一特征对黑色素瘤具有高度特异性。
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