Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Br J Dermatol. 2021 Aug;185(2):302-312. doi: 10.1111/bjd.19759. Epub 2021 Mar 4.
Early detection of melanoma is essential to reduce mortality. Total body photography (TBP) can facilitate the detection of melanoma in high-risk individuals. However, the accuracy of TBP in diagnosing melanoma remains unclear.
To determine the diagnostic accuracy of TBP for the detection of melanoma in adults.
MEDLINE, Embase, Cochrane and Centre for Reviews databases were searched from inception to 26 May 2020. Studies that included TBP for diagnosing melanoma with at least one follow-up appointment were eligible for inclusion in the systematic review if they provided data to calculate at least one diagnostic accuracy measure. Two authors independently screened articles, extracted data and assessed quality. Disagreements were resolved by a third reviewer.
In total, 10 studies were included, comprising 41 703 patients who underwent TBP and 6203 biopsies. Melanoma in situ (MIS) was diagnosed in 315 (5·1%) lesions and invasive melanoma was diagnosed in 187 (3·0%) lesions biopsied. Summary estimates for TBP in diagnosing melanoma were calculated as follows: mean percentage of biopsies positive for MIS or melanoma was 15% [95% confidence interval (CI) 10-21], number needed to biopsy (NNB) was 8·6 (range 2·3-19·6), naevus : melanoma ratio was 7·6 (range 1·3-18·6), and MIS : melanoma ratio was 1·7 (1·0-3·5). Regression analysis showed a negative correlation between NNB and MIS : melanoma ratio.
Available data regarding the diagnostic accuracy of TBP are heterogeneous, owing to variability in the risk profile of cohorts and TBP protocols. Best current estimates suggest that TBP for diagnosing melanoma has an acceptable NNB in high-risk patients. However, prospective diagnostic test accuracy studies are needed to gauge the diagnostic accuracy of TBP.
早期发现黑色素瘤对于降低死亡率至关重要。全身摄影（TBP）可以帮助高风险人群发现黑色素瘤。然而，TBP 诊断黑色素瘤的准确性尚不清楚。
确定 TBP 用于诊断成人黑色素瘤的准确性。
从建库到 2020 年 5 月 26 日，检索了 MEDLINE、Embase、Cochrane 和综述中心数据库。如果研究提供了至少一项诊断准确性测量数据，且包含 TBP 用于诊断黑色素瘤的至少一项后续预约，则符合纳入系统综述的条件。两名作者独立筛选文章、提取数据并评估质量。意见分歧由第三位审稿人解决。
共纳入 10 项研究，包含 41703 例接受 TBP 和 6203 例活检的患者。315 例（5.1%）病变诊断为原位黑色素瘤（MIS），187 例（3.0%）活检诊断为侵袭性黑色素瘤。计算 TBP 诊断黑色素瘤的汇总估计值如下：MIS 或黑色素瘤活检阳性的平均百分比为 15%[95%置信区间（CI）10-21]，活检所需例数（NNB）为 8.6（范围 2.3-19.6），痣：黑色素瘤比值为 7.6（范围 1.3-18.6），MIS：黑色素瘤比值为 1.7（1.0-3.5）。回归分析显示，NNB 与 MIS：黑色素瘤比值呈负相关。
由于队列和 TBP 方案风险特征的变异性，关于 TBP 诊断准确性的现有数据存在异质性。目前最佳估计表明，TBP 用于诊断黑色素瘤在高危患者中有可接受的 NNB。然而，需要前瞻性诊断准确性研究来评估 TBP 的诊断准确性。
