Tozawa Asami, Mori Hideki, Ao Masakazu, Miyauchi Ritsuko, Tsuji Yasumi, Matsumoto Mayu, Murakami Masamoto, Nakaoka Hiroki, Fujisawa Yasuhiro
Division of Plastic and Reconstructive Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan.
J Plast Reconstr Surg. 2023 Sep 8;3(1):29-33. doi: 10.53045/jprs.2021-0037. eCollection 2024 Jan 27.
Although several studies have investigated the accuracy of clinical diagnoses of skin tumors, specific ways to improve diagnostic accuracy have not been identified. This study investigated factors that influence the accuracy of clinical skin tumor diagnostic methods and discusses strategies to improve accuracy.
Study 1 retrospectively analyzed 657 skin tumors excised at our hospital between March 2001 and March 2011. Data were extracted from surgical records to establish a diagnostic template for further research. Study 2 prospectively applied this template to aid clinical diagnosis at four facilities between April 2011 and March 2013. The clinical diagnoses were compared with the histological ones and the concordance was determined.
A total of 448 and 209 benign and malignant tumors, respectively, were included in Study 1. The overall diagnostic accuracy was 79.0%. In Study 2, 310 patients were clinically diagnosed using a standardized template, which did not affect the diagnostic accuracy. Age, sex, duration of disease, tumor size and location, skin tone, mobility, stiffness, and years of diagnostic experience did not significantly affect diagnostic accuracy. A high proportion of pathologically malignant tumors were clinically misdiagnosed as benign (16/22; 72%). Other clinical examinations were performed in only 35 cases.
Auxiliary diagnostic tools such as dermoscopy and biopsies should be used to accurately diagnose malignant tumors.
尽管多项研究调查了皮肤肿瘤临床诊断的准确性，但尚未确定提高诊断准确性的具体方法。本研究调查了影响皮肤肿瘤临床诊断方法准确性的因素，并探讨了提高准确性的策略。
研究1回顾性分析了2001年3月至2011年3月间在我院切除的657例皮肤肿瘤。从手术记录中提取数据，建立诊断模板以供进一步研究。研究2前瞻性地将该模板应用于2011年4月至2013年3月间四个机构的临床诊断。将临床诊断与组织学诊断进行比较，并确定一致性。
研究1共纳入448例良性肿瘤和209例恶性肿瘤。总体诊断准确率为79.0%。在研究2中，310例患者使用标准化模板进行临床诊断，这并未影响诊断准确性。年龄、性别、病程、肿瘤大小和位置、肤色、活动度、硬度以及诊断经验年限均未显著影响诊断准确性。相当一部分病理诊断为恶性的肿瘤在临床上被误诊为良性（16/22；72%）。仅35例进行了其他临床检查。
应使用皮肤镜检查和活检等辅助诊断工具来准确诊断恶性肿瘤。
