Churchill Robert A, Pecoraro Trisha Y C, Tooley Andrea A, Houghton Odette M, Mashayekhi Arman, Dalvin Lauren A
Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.
Eye (Lond). 2024 Mar;38(4):798-805. doi: 10.1038/s41433-023-02782-8. Epub 2023 Oct 25.
Risk factors for small choroidal melanocytic lesion growth to melanoma have been redefined using multimodal imaging. We explored provider ability to recognize risk factors for small choroidal melanocytic lesion growth to melanoma before and after image-based education and with and without multimodal imaging.
Providers were invited to participate in a survey assessing ability to identify risk factors for small choroidal melanocytic lesion growth to melanoma using either fundus imaging or multimodal imaging. Risk factors included thickness >2 mm on ultrasonography, subretinal fluid on optical coherence tomography, presence of orange pigment by autofluorescence, acoustic hollowness by ultrasonography, and diameter >5 mm by fundus imaging. Performance was assessed before and after reviewing an educational PowerPoint providing pictorial examples of risk factors. Comparison between groups was conducted using two-tailed Fisher's exact test.
Thirty and 26 providers completed the pre-education and post-education assessments, respectively. Post-education participants were more accurate within ±1 risk factor for lesions with zero risk factors (77% vs. 100%, p = 0.01) or two risk factors (79% vs. 91%, p = 0.03). Following education, participants presented with multimodal imaging more often correctly identified lesions with four (12% vs. 42%, p = 0.03) or five (4% vs. 39%, p = 0.004) risk factors, demonstrated lower mean level of concern for lesions with zero risk factors (2.0 vs. 1.4, p < 0.001), and expressed higher level of concern for lesions with 5 risk factors (2.4 vs. 3.6, p < 0.001).
Use of multimodal imaging may be more beneficial than education itself to improve accuracy of risk factor identification for small choroidal melanocytic lesions.
利用多模态成像重新定义了小脉络膜黑素细胞病变发展为黑色素瘤的危险因素。我们探讨了在基于图像的教育前后以及有无多模态成像的情况下，医疗人员识别小脉络膜黑素细胞病变发展为黑色素瘤的危险因素的能力。
邀请医疗人员参与一项调查，评估其使用眼底成像或多模态成像识别小脉络膜黑素细胞病变发展为黑色素瘤的危险因素的能力。危险因素包括超声检查时厚度>2毫米、光学相干断层扫描显示视网膜下液、自发荧光显示橙色色素、超声检查显示声学空洞以及眼底成像显示直径>5毫米。在查看提供危险因素图片示例的教育性幻灯片前后评估表现。使用双尾Fisher精确检验进行组间比较。
分别有30名和26名医疗人员完成了教育前和教育后评估。教育后，对于无危险因素（77%对100%，p = 0.01）或有两个危险因素（79%对91%，p = 0.03）的病变，参与者在±1个危险因素范围内的准确性更高。教育后，使用多模态成像的参与者更常正确识别有四个（12%对42%，p = 0.03）或五个（4%对39%，p = 0.004）危险因素的病变，对无危险因素病变的平均关注程度较低（2.0对1.4，p < 0.001），对有五个危险因素病变的关注程度较高（2.4对3.6，p < 0.001）。
使用多模态成像可能比教育本身更有助于提高小脉络膜黑素细胞病变危险因素识别的准确性。
