Dermatology Department, University Hospitals Brugmann & Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Mycoses. 2021 Feb;64(2):187-193. doi: 10.1111/myc.13201. Epub 2020 Nov 9.
Onychomycosis affects 5.5% of the general population and represents up to 50% of all nail diseases. Diagnosis and pathogen identification are essential in order to plan an adequate treatment. Many diagnostic techniques are available, and however, no solid data regarding comparison between different techniques over a large number of specimens are available to date.
To compare sensitivity and specificity of direct examination, histopathology and fungal culture in our referral mycology laboratory.
Nail specimens received at the cutaneous pathology and mycology laboratory of the University Hospital Saint-Pierre (Brussels, Belgium) between 1 January and 15 May 2018 were retrospectively analysed. All specimens were submitted to direct examination and culture. In cases of adequate specimen size, histopathology was performed. Fungal culture was considered the gold standard for diagnosis.
A total of 2245 nail samples were included in the study. Onychomycosis was diagnosed in 1266 specimens. Sensitivity and positive predictive value were found to be higher for direct examination compared to histopathology, while sensitivity of direct examination was found to be lower. Combined approach with all the three techniques showed the highest rate of positivity, followed by the association of direct examination and histopathology.
To our knowledge, this study included the largest number of nail specimens to date, allowing a comparison between direct examination, culture and histopathology. Direct examination showed to be the most performing technique in routine practice. Histopathology represents the most effective option in cases where both specimen size and laboratory resources are adequate. Our paper adds to the literature the 'real-life' experience of the mycology laboratory of a referral centre for nail diseases.
甲真菌病影响 5.5%的普通人群，占所有指甲疾病的 50%。为了制定适当的治疗方案，诊断和病原体鉴定至关重要。有许多诊断技术，但迄今为止，尚无关于大量标本的不同技术之间比较的可靠数据。
比较我们的真菌病参考实验室中直接镜检、组织病理学和真菌培养的灵敏度和特异性。
回顾性分析 2018 年 1 月 1 日至 5 月 15 日期间在布鲁塞尔圣皮埃尔大学医院皮肤科病理和真菌病实验室收到的指甲标本。所有标本均进行直接镜检和培养。在标本大小足够的情况下，进行组织病理学检查。真菌培养被认为是诊断的金标准。
共有 2245 份指甲样本纳入研究。1266 份标本诊断为甲真菌病。与组织病理学相比，直接镜检的灵敏度和阳性预测值更高，而直接镜检的灵敏度较低。三种技术联合应用显示阳性率最高，其次是直接镜检和组织病理学联合应用。
据我们所知，这项研究纳入了迄今为止数量最多的指甲标本，可比较直接镜检、培养和组织病理学。直接镜检在常规实践中是表现最出色的技术。在标本大小和实验室资源充足的情况下，组织病理学是最有效的选择。我们的论文增加了指甲疾病参考中心真菌病实验室的“现实”经验。
