Nätterdahl Carolina, Kristensson Hedvig, Persson Bertil, Lapins Jan, Ivert Lina U, Radros Niki, Schultz Karina, Sand Cecilia, Lundgren Sigrid, Pahlow Mose Anja, Ingvar Jonas, Dizdarevic Adis, Nielsen Kari, Ingvar Åsa
Department of Clinical Sciences, Dermatology and Venereology, Lund Skin Cancer Research Group, Lund University, Lund, Sweden.
Department of Dermatology, Skåne University Hospital, Lund, Sweden.
Telemed J E Health. 2025 May;31(5):579-589. doi: 10.1089/tmj.2024.0532. Epub 2025 Jan 27.
Teledermoscopy (TDS) emerges as an efficient tool for diagnosing skin lesions. In Sweden, double reading is the standard of care, but risk factors for misdiagnosis or mismanagement using single reader evaluations (SRE) are not well-studied. This study aimed to assess the accuracy of SRE compared with the gold standard in TDS. This retrospective cohort study involved 1,997 TDS referrals sent from general practitioners to dermatologists in Stockholm, Sweden, selected based on dermoscopic diagnoses. All referrals underwent double reader evaluations (DRE). Each case was reassessed by a single external assessor, blinded to the DRE result. Based on predefined rules, a gold standard for the most correct diagnosis was established. Diagnostic accuracy and risk factors for misdiagnosis were evaluated. The trial was registered on ClinicalTrials.gov (ID NCT05033678). Primary diagnosis by SRE agreed with the gold standard on benign-malignant classification in 84% of cases. Discordance was linked to lower diagnostic confidence and more frequent recommendations for further intervention. SRE achieved a benign-malignant sensitivity and specificity of 84% (95% confidence interval: 81-87% and 82-86%, respectively). The risk of overdiagnosis increased 96 times when assessors reported being "very unconfident." Out of a total of 311 melanomas, melanoma , lentigo maligna, and severely dysplastic nevi, 62 were not recognized in the SRE primary diagnosis. However, 50 of these misdiagnosed lesions were still recommended for accurate management. The confidence level of TDS assessors heavily influences diagnostic accuracy. Therefore, when diagnostic confidence is perceived as moderate or low, additional interventions should be considered.
远程皮肤镜检查（TDS）成为诊断皮肤病变的一种有效工具。在瑞典，双人阅片是标准的诊疗方式，但对于使用单人阅片评估（SRE）时误诊或管理不当的风险因素尚未得到充分研究。本研究旨在评估SRE与TDS金标准相比的准确性。这项回顾性队列研究涉及从瑞典斯德哥尔摩的全科医生转介给皮肤科医生的1997例TDS病例，这些病例是根据皮肤镜诊断选择的。所有转介病例均接受双人阅片评估（DRE）。每个病例由一名独立的外部评估者重新评估，该评估者对DRE结果不知情。根据预先定义的规则，确立了最正确诊断的金标准。评估了诊断准确性和误诊的风险因素。该试验已在ClinicalTrials.gov上注册（ID NCT05033678）。SRE的初步诊断在84%的病例中与金标准的良恶性分类一致。不一致与较低的诊断信心以及更频繁的进一步干预建议有关。SRE的良恶性敏感性和特异性分别为84%（95%置信区间：81 - 87%和82 - 86%）。当评估者报告“非常不自信”时，过度诊断的风险增加了96倍。在总共311例黑色素瘤、恶性雀斑样痣和重度发育异常痣中，有62例在SRE初步诊断中未被识别。然而，这些误诊的病变中有50例仍被建议进行准确的管理。TDS评估者的信心水平严重影响诊断准确性。因此，当诊断信心被认为是中等或较低时，应考虑采取额外的干预措施。
