初级保健中高危基底细胞癌切除术：一项符合 NICE 指南的回顾性观察性研究。
High-risk basal cell carcinoma excision in primary care: a retrospective observational study of compliance with NICE guidance.
机构信息
Ear, Nose and Throat Department, University Hospital Coventry, Coventry, UK.
Plastic Surgery Department, Salisbury District Hospital, Salisbury, UK.
出版信息
BMJ Open. 2019 Feb 22;8(11):e023299. doi: 10.1136/bmjopen-2018-023299.
OBJECTIVES
To assess compliance with 2010 National Institute for Health and Care Excellence (NICE) guidance on cancer services relating to the management of basal cell carcinomas (BCC) in the community, where except in specific circumstances it is recommended that only low-risk BCCs should be excised routinely.
DESIGN AND SETTING
A retrospective observational study of the histopathology reports of BCC excisions received from primary care in two district general hospitals in the South of England. One hundred consecutive BCC excisions were analysed from each hospital.
OUTCOME MEASURES
The numbers of high-risk BCCs excised in primary care according to histological subtype, anatomical site and age and if these excisions were compliant with NICE 2010 guidance. Completeness of excision and mention of BCC on histology request were secondary outcomes.
RESULTS
Histologically high-risk subtypes were present in 32% (64/200) of BCCs excised in the community. Only 17/64 were excised by general practitioners (GPs) who were accredited to do so. Non-compliance regarding anatomical site occurred in 16% of samples; only one was non-compliant regarding patient age. There was a high overall rate of complete excision (94.5%) with variation in presence of the term BCC on histology request forms.
CONCLUSIONS
NICE 2010 guidance relating to BCC excision in primary care was not followed in a considerable number of cases. Compliance with NICE 2010 guidance depends on the ability to recognise high-risk BCCs clinically and manage appropriately. It also shows that despite close supervision by secondary care, there are still failures of compliance.GP training in identification of subtypes of BCC might be improved, as well as an increase in numbers of GPs accredited to carry out high-risk BCC excisions. Difficulty in diagnosing high-risk histological subtypes of BCC preoperatively should be considered in any future revision of NICE guidance.
目的
评估社区中基底细胞癌（BCC）管理方面是否符合 2010 年国家健康与保健卓越研究所（NICE）关于癌症服务的指南，该指南建议除特殊情况外，仅应常规切除低危 BCC。
设计和设置
这是一项在英格兰南部的两家地区综合医院进行的回顾性观察性研究，对来自初级保健的 BCC 切除组织病理学报告进行了分析。每个医院均分析了 100 例连续的 BCC 切除术。
结果
根据组织学亚型、解剖部位和年龄，在初级保健中切除的高危 BCC 数量以及这些切除术是否符合 NICE 2010 年的指南。切除的完整性和组织学请求中提及 BCC 是次要结果。
结果
在社区中切除的 200 例 BCC 中，有 32%（64/200）为组织学高危亚型。仅 17/64 例由有资格进行此操作的全科医生（GP）切除。在 16%的样本中，解剖部位存在不规范；只有 1 例患者年龄不规范。总体上完全切除率很高（94.5%），但组织学请求表中存在 BCC 一词的情况存在差异。
结论
在相当多的情况下，初级保健中 NICE 2010 年有关 BCC 切除的指南并未得到遵循。对 NICE 2010 年指南的遵守取决于能否在临床上识别高危 BCC 并进行适当的治疗。这也表明，尽管受到二级保健的严格监督，但仍存在违反规定的情况。可能需要改善全科医生对 BCC 亚型的识别培训，以及增加获得认可进行高危 BCC 切除术的全科医生人数。在对 NICE 指南进行任何修订时，都应考虑术前诊断高危组织学 BCC 亚型的困难。
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