Pezzini C, Kaleci S, Chester J, Farnetani F, Longo C, Pellacani G
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy.
J Eur Acad Dermatol Venereol. 2020 Oct;34(10):2268-2279. doi: 10.1111/jdv.16248. Epub 2020 Feb 27.
The diagnostic accuracy of reflectance confocal microscopy (RCM) of cutaneous malignant melanoma (MM) seems promising. However, clinical scenarios in which RCM is most useful are still to be established.
To assess the diagnostic accuracy of RCM for MM diagnosis according to study design, lesion type and diagnostic modality. Secondary outcomes include a comparison with dermoscopy.
A systematic literature search was conducted on PubMed, Embase, Scopus and Cochrane Public Library Databases for English articles published prior to January 2019. Statistical analyses were conducted with Meta-Disc v. 1.4, STATA 14.0 software and the QUADAS-2 tool.
A total of 32 studies (7352 lesions) were included in the meta-analysis. Pooled sensitivity and specificity resulted 92% (95% CI: 0.91-0.93) and 70% (95% CI: 0.69-0.71), respectively. According to study design, diagnostic sensitivity was high for all study types, confirming a lower specificity for prospective interventional studies. Diagnostic accuracy remained high for all lesion types, with the highest specificity obtained for consecutive lesions of 77% (95% CI: 0.75-0.78) vs. 65% (95% CI: 0.63-0.66) for lesions highly suspicious for MM. RCM diagnostic accuracy was superior to dermoscopy, most notably in terms of specificity of 56% (95% CI: 0.52-0.60) vs. 38% (95% CI: 0.34-0.42), respectively. Studies were generally assessed across all domains as low or unclear risk of bias with a mainly low concern regarding applicability of evidence. Publication bias was asymmetrical (11.2 ± 4.0; 95% CI 2.97-19.43; P < 0.01).
Independent of study design, RCM has a high diagnostic power for MM detection, and unnecessary excisions are reduced compared to dermoscopy. This reduction is most evident in non-decisional RCM scenarios and for lesions analysed at RCM consecutively compared to those selected highly suspicious for MM. However, the scarcity, heterogeneity and bias associated with the data in literature should be considered when interpreting present conclusions.
反射式共聚焦显微镜（RCM）对皮肤恶性黑色素瘤（MM）的诊断准确性似乎很有前景。然而，RCM最有用的临床场景仍有待确定。
根据研究设计、病变类型和诊断方式评估RCM对MM诊断的准确性。次要结果包括与皮肤镜检查的比较。
在PubMed、Embase、Scopus和Cochrane公共图书馆数据库中对2019年1月之前发表的英文文章进行系统的文献检索。使用Meta-Disc v. 1.4、STATA 14.0软件和QUADAS-2工具进行统计分析。
荟萃分析共纳入32项研究（7352个病变）。合并敏感性和特异性分别为92%（95%CI：0.91-0.93）和70%（95%CI：0.69-0.71）。根据研究设计，所有研究类型的诊断敏感性都很高，前瞻性干预研究的特异性较低得到证实。所有病变类型的诊断准确性仍然很高，连续病变的特异性最高，为77%（95%CI：0.75-0.78），而高度怀疑MM的病变为65%（95%CI：0.63-0.66）。RCM的诊断准确性优于皮肤镜检查，最明显的是在特异性方面，分别为56%（95%CI：0.52-0.60）和38%（95%CI：0.34-0.42）。总体而言，所有领域的研究在偏倚风险方面被评估为低或不明确，对证据适用性的关注主要较低。发表偏倚是不对称的（11.2 ± 4.0；95%CI 2.97-19.43；P < 0.01）。
独立于研究设计，RCM对MM检测具有较高的诊断能力，与皮肤镜检查相比，不必要的切除减少。这种减少在非决定性RCM场景中以及与高度怀疑MM的病变相比连续进行RCM分析的病变中最为明显。然而，在解释当前结论时应考虑文献中数据的稀缺性、异质性和偏倚。
