Koch C, Martens A, Hainisch E K, Schüpbach G, Gerber V, Haspeslagh M
Swiss Institute of Equine Medicine, University of Berne, and Agroscope, Länggassstrasse 124, Postfach 8466, CH-3001 Berne, Switzerland.
Department of Surgery and Anaesthesiology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
Vet J. 2018 Dec;242:77-82. doi: 10.1016/j.tvjl.2018.08.009. Epub 2018 Sep 1.
Equine clinicians and researchers often make the diagnosis of equine sarcoids (ES) on clinical assessment alone, without histopathological confirmation. However, the accuracy of the clinical diagnosis of ES has not been critically assessed. To assess sensitivity, specificity, positive and negative predictive values of the clinical diagnosis of ES, 40 clinical cases with histologically confirmed equine skin lesions (26 ES and 14 non-ES) were compiled in a representative online examination. For each case and lesion, at least one photograph and all relevant information were presented in a standardised format. This included the horse's signalment, lesion localisation, lesion progression, presence of other skin lesions, earlier treatments and response to treatment. No information relevant for the assessment of the lesion was intentionally withheld. Fourteen ES experts, 39 board-certified equine specialists, 103 equine practitioners and 25 novices categorised the cases into ES or non-ES and graded their level of diagnostic confidence on a scale from 1 to 6 for each case. The overall success rate was 82.0% while sensitivity and specificity were 83.3% and 79.6%, respectively. The positive and negative predictive values were 88.4% and 72.0%, respectively, in the tested population with a 66% prevalence of ES. However, less experienced veterinarians were frequently wrong in their clinical judgement despite a high level of diagnostic confidence. Therefore, the authors propose to develop a diagnostic tool to help clinicians optimise their selection of lesions requiring a biopsy. Ultimately, this will help reduce costs and morbidity generated by unnecessary diagnostic and therapeutic efforts.
马科临床医生和研究人员常常仅通过临床评估就对马肉瘤（ES）进行诊断，而无需组织病理学确认。然而，ES临床诊断的准确性尚未得到严格评估。为了评估ES临床诊断的敏感性、特异性、阳性预测值和阴性预测值，在一项具有代表性的在线检查中收集了40例经组织学确诊的马皮肤病变临床病例（26例ES和14例非ES）。对于每个病例和病变，至少有一张照片和所有相关信息以标准化格式呈现。这包括马匹的特征、病变部位、病变进展、其他皮肤病变的存在情况、早期治疗以及对治疗的反应。没有故意隐瞒与病变评估相关的信息。14名ES专家、39名获得委员会认证的马科专家、103名马科从业者和25名新手将这些病例分类为ES或非ES，并针对每个病例在1至6的量表上对其诊断信心水平进行评分。总体成功率为82.0%，而敏感性和特异性分别为83.3%和79.6%。在ES患病率为66%的受试人群中，阳性预测值和阴性预测值分别为88.4%和72.0%。然而，经验较少的兽医尽管诊断信心很高，但在临床判断中经常出错。因此，作者建议开发一种诊断工具，以帮助临床医生优化对需要活检的病变的选择。最终，这将有助于降低不必要的诊断和治疗努力所产生的成本和发病率。
