Müller Christoph, Kittler Harald, Tschandl Philipp, Rinner Christoph, Grausenburger Marie-Luise, Kyrgidis Athanassios, Koga Hiroshi, Moscarella Elvira, Apalla Zoe, Di Stefani Alessandro, Kobayashi Ken, Lazaridou Elisabeth, Longo Caterina, Phan Alice, Saida Toshiaki, Sotiriou Elena, Tanaka Masaru, Thomas Luc, Zalaudek Iris, Argenziano Giuseppe, Lallas Aimilios
Department of Dermatology, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Dermatology. 2024;240(5-6):793-802. doi: 10.1159/000541591. Epub 2024 Oct 5.
Diagnosis of acral melanocytic lesions can be challenging. The BRAAFF checklist was introduced as a tool to help differentiate between acral nevi and melanoma but has not been validated.
We asked raters with varying expertise in dermatoscopy to diagnose dermatoscopic images of 533 acral nevi and 144 melanomas via an online platform with and without use of the BRAAFF checklist. From the ratings, we calculated sensitivity, specificity, and interrater agreement. Additionally, a new simplified version of the checklist was also tested.
We collected 6,880 ratings from 175 readers. The BRAAFF checklist achieved a sensitivity of 92.5% and a specificity of 65.0%, which was similar to diagnosis from pattern recognition (sensitivity 90.0%, specificity: 72.1%). Interrater agreement for the BRAAFF criteria ranged from fair to moderate, with lowest agreement for parallel ridge and fibrillar pattern (alpha = 0.31) and highest for asymmetry of colors and structures (alpha = 0.46). Agreement and diagnostic accuracy were higher for more experienced readers. A simplified version with only two criteria achieved similar sensitivity (95.0%) and lower specificity (60.0%) as the original BRAAFF checklist.
The BRAAFF checklist is a useful tool for the diagnosis of melanocytic acral lesions with acceptable sensitivity and reasonable specificity but is not superior to pattern recognition. A simplified version of the checklist could be easier to use with equal sensitivity while exhibiting a modest reduction in specificity.
肢端黑素细胞性病变的诊断可能具有挑战性。BRAAFF检查表被引入作为一种有助于区分肢端痣和黑色素瘤的工具，但尚未得到验证。
我们让在皮肤镜检查方面具有不同专业知识的评估者通过一个在线平台，在使用和不使用BRAAFF检查表的情况下，对533例肢端痣和144例黑色素瘤的皮肤镜图像进行诊断。根据评分，我们计算了敏感性、特异性和评估者间一致性。此外，还对检查表的一个新的简化版本进行了测试。
我们从175名读者那里收集了6880份评分。BRAAFF检查表的敏感性为92.5%，特异性为65.0%，这与基于模式识别的诊断结果相似（敏感性90.0%，特异性72.1%）。BRAAFF标准的评估者间一致性从中等到一般，其中平行嵴和纤维状模式的一致性最低（α = 0.31），颜色和结构不对称性的一致性最高（α = 0.46）。经验更丰富的读者的一致性和诊断准确性更高。一个只有两个标准的简化版本与原始BRAAFF检查表相比，具有相似的敏感性（95.0%）和更低的特异性（60.0%）。
BRAAFF检查表是诊断黑素细胞性肢端病变的有用工具，具有可接受的敏感性和合理的特异性，但并不优于模式识别。检查表的简化版本可能更易于使用，敏感性相同，但特异性略有降低。
