体内共聚焦显微镜：比较方法在多发性非典型痣患者中的作用。
In vivo confocal microscopy: The role of comparative approach in patients with multiple atypical nevi.
机构信息
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
出版信息
Exp Dermatol. 2020 Oct;29(10):945-952. doi: 10.1111/exd.14162. Epub 2020 Sep 21.
BACKGROUND
In vivo reflectance confocal microscopy (RCM) increases diagnostic accuracy for melanoma diagnosis when combined with dermoscopy. In patients with multiple atypical nevi, a comparative dermoscopic approach improves melanoma recognition and saves unnecessary excision. The performance of a comparative approach combining dermoscopy and RCM has not been yet investigated.
OBJECTIVE
To validate a comparative dermoscopic + RCM approach according to melanoma diagnostic accuracy in patients with multiple atypical nevi.
METHODS
Consecutive patients undergoing RCM examination for ≥3 atypical melanocytic lesions, assessed with a dermoscopic + RCM comparative approach in a real-life setting, from July 2012 to April 2018 at a single centre, were enrolled. Dermoscopic and dermoscopic + RCM morphologic approaches were retrospectively applied by evaluating revisited 7-point checklist, RCM and Delphi scores for each enrolled lesion. Comparative dermoscopic and dermoscopic + RCM approaches were subsequently used. For each approach, lesions were classified as non-suspicious (long-term follow-up) or suspicious (short-term follow-up or excision) and diagnostic accuracy for melanoma diagnosis was assessed.
RESULTS
Diagnostic accuracy progressively increased comparing morphologic to comparative approaches, and comparing dermoscopic to dermoscopic + RCM approaches. The retrospective comparative dermoscopic + RCM approach revealed the largest area under the curve (0.84; 95%CI:0.79-0.89; P < .001) and the lowest number needed to excise (5.7). Furthermore, this approach had the highest specificity (67.6%) and sensitivity (100%) levels, which were similar to those verified in the real-life setting. The main study limitations are the retrospective design and high-risk patient inclusion only.
CONCLUSIONS
Comparative dermoscopic + RCM approach increases melanoma diagnostic accuracy, reducing unnecessary excision without missing melanomas.
背景
体内共聚焦激光扫描显微镜（RCM）与皮肤镜检查相结合，可提高黑色素瘤诊断的准确性。对于多发性非典型痣患者，比较皮肤镜检查可提高黑色素瘤的识别能力并避免不必要的切除。目前尚未研究比较皮肤镜检查和 RCM 相结合的方法。
目的
验证一种比较皮肤镜检查+RCM 方法，以提高多发性非典型痣患者的黑色素瘤诊断准确性。
方法
连续纳入 2012 年 7 月至 2018 年 4 月在一家单中心接受 RCM 检查的至少 3 个非典型黑素细胞病变患者，采用比较皮肤镜检查+RCM 的方法进行评估。在回顾性研究中，通过评估重新检查的 7 分检查表、RCM 和 Delphi 评分，对每个纳入的病变应用皮肤镜和皮肤镜+RCM 形态学方法。随后应用比较皮肤镜和皮肤镜+RCM 方法。对于每种方法，病变分为非可疑（长期随访）或可疑（短期随访或切除），并评估黑色素瘤诊断的准确性。
结果
与形态学方法相比，比较方法的诊断准确性逐渐提高，与皮肤镜方法相比，皮肤镜+RCM 方法的诊断准确性也逐渐提高。回顾性比较皮肤镜检查+RCM 方法的曲线下面积最大（0.84；95%CI：0.79-0.89；P<0.001），需要切除的病变数量最少（5.7）。此外，该方法具有最高的特异性（67.6%）和敏感性（100%），与真实环境下的验证结果相似。主要研究局限性在于回顾性设计和高危患者纳入。
结论
比较皮肤镜检查+RCM 方法可提高黑色素瘤的诊断准确性，减少不必要的切除，同时不遗漏黑色素瘤。
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