From the North Florida Family Medicine, Lake City FL, USA (MT); HonorHealth Research Institute, Scottsdale AZ, USA (DB); University of South Florida, Morsani College of Medicine, Department of Family Medicine, Tampa FL, USA (KH); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY (AB); The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney NSW, Australia (LB); Medical Dermatology Specialists, Phoenix AZ, USA (NCZ).
J Am Board Fam Med. 2024 May-Jun;37(3):427-435. doi: 10.3122/jabfm.2023.230256R2.
Access to dermatologists is limited in parts of the US, making primary care clinicians (PCCs) integral for early detection of skin cancers. A handheld device using elastic scattering spectroscopy (ESS) was developed to aid PCCs in their clinical assessment of skin lesions.
In this prospective study, 3 PCCs evaluated skin lesions reported by patients as concerning and scanned each lesion with the handheld ESS device. The comparison was pathology results or a 3-dermatologist panel examining high resolution dermatoscopic and clinical images. PCCs reported their diagnosis, management decision, and confidence level for each lesion. Evaluation of results included sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and Area Under the Curve (AUC).
A total of 155 patients and 178 lesions were included in the final analysis. The most commonly patient-reported concerning feature was "new or changing lesion" (91.6%). Device diagnostic sensitivity and specificity were 90.0% and 60.7%, respectively, based on biopsy result or dermatologist panel reference standard; comparatively, PCC sensitivity was 40.0% and 84.8% specificity without the use of the device. Device NPV was 98.9%, and device PPV was 13.6%. The device recommended patient referral to dermatology with 88.2% concordance with the dermatologist panel. AUC for the device and PCCs were 0.815 and 0.643, respectively.
The use of the ESS device by PCCs can improve diagnostic and management sensitivity for select malignant skin lesions by correctly classifying most benign lesions of patient concern. This may increase skin cancer detection while improving access to specialist care.
在美国的某些地区，皮肤科医生的资源有限，因此初级保健临床医生（PCC）对于早期发现皮肤癌至关重要。已经开发出一种使用弹性散射光谱（ESS）的手持式设备，以帮助 PCC 对皮肤病变进行临床评估。
在这项前瞻性研究中，3 名 PCC 评估了患者报告的有问题的皮肤病变，并使用手持式 ESS 设备对每个病变进行了扫描。比较结果是病理学结果或由 3 名皮肤科医生组成的小组，他们检查了高分辨率皮肤镜和临床图像。PCC 报告了他们对每个病变的诊断、管理决策和信心水平。对结果的评估包括敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和曲线下面积（AUC）。
共有 155 名患者和 178 个病变纳入最终分析。最常见的患者报告的令人担忧的特征是“新的或变化的病变”（91.6%）。基于活检结果或皮肤科医生小组参考标准，设备诊断的敏感性和特异性分别为 90.0%和 60.7%；相比之下，不使用设备时，PCC 的敏感性为 40.0%，特异性为 84.8%。设备的 NPV 为 98.9%，PPV 为 13.6%。该设备建议将患者转介给皮肤科医生，与皮肤科医生小组的一致性为 88.2%。设备和 PCC 的 AUC 分别为 0.815 和 0.643。
PCC 使用 ESS 设备可以通过正确分类大多数患者关注的良性病变，提高选择恶性皮肤病变的诊断和管理敏感性。这可能会增加皮肤癌的检出率，同时改善对专科护理的获取。
