Shaigany Sheila, Steuer Alexa, Seminara Nicole, Brinster Nooshin, Femia Alisa
Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
New York University School of Medicine, New York, New York.
J Am Acad Dermatol. 2020 Jun;82(6):1400-1408. doi: 10.1016/j.jaad.2020.01.047. Epub 2020 Jan 28.
In instances of suspected cutaneous infection, the standard of care includes obtaining skin biopsy specimens for histology and tissue culture. Few studies have compared the clinical utility of each test.
To assess the concordance of results between tissue culture and histology, as well as the clinicopathologic features that may influence the diagnostic yield of each test.
A retrospective review of all patients who underwent skin biopsy for histology and tissue culture at New York University from 2013 through 2018.
Of 179 patients, 10% had positive concordance, 21% had positive tissue culture only, and 7% had positive histology only. We calculated a kappa correlation coefficient of 0.25 between histology and tissue culture (reference, 0.21-0.39 indicates minimal agreement). Histology exhibited higher sensitivity in detecting fungi, whereas tissue culture was more sensitive in identifying Gram-negative bacteria. Antimicrobial use before biopsy led to significantly fewer positive cultures (37.5% vs 71%; P = .023) in patients ultimately diagnosed with infection.
This study was conducted at a single institution, thereby restricting its broad applicability. The lack of a validated criterion standard to diagnose infection also limits interpretation of the results.
Tissue culture and histopathology often yield discordant results. Dermatologists should recognize specific limitations, yet high clinical utility in special circumstances, of tests when approaching cases of suspected infection.
在疑似皮肤感染的病例中，标准治疗方案包括获取皮肤活检标本进行组织学检查和组织培养。很少有研究比较这两种检查的临床效用。
评估组织培养和组织学检查结果的一致性，以及可能影响每种检查诊断率的临床病理特征。
对2013年至2018年在纽约大学接受皮肤活检进行组织学检查和组织培养的所有患者进行回顾性研究。
179例患者中，10%结果一致为阳性，21%仅组织培养结果为阳性，7%仅组织学检查结果为阳性。我们计算出组织学检查和组织培养之间的kappa相关系数为0.25（参考值，0.21 - 0.39表示一致性较低）。组织学检查在检测真菌方面表现出更高的敏感性，而组织培养在鉴定革兰氏阴性菌方面更敏感。活检前使用抗菌药物导致最终被诊断为感染的患者中阳性培养结果显著减少（37.5%对71%；P = 0.023）。
本研究在单一机构进行，因此限制了其广泛适用性。缺乏用于诊断感染的经过验证的标准也限制了对结果的解释。
组织培养和组织病理学检查结果往往不一致。皮肤科医生在处理疑似感染病例时应认识到这些检查的特定局限性以及在特殊情况下的高临床效用。
