Wolswijk Tom, Nelemans Patricia Joan, Adan Fieke, van Leersum Frank, Kreiter Daniel, Adams Thomas, van Dorsten Sem, Mosterd Klara
Department of Dermatology, Maastricht University Medical Center +, Maastricht, the Netherlands.
GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
Int J Dermatol. 2025 Oct;64(10):1870-1878. doi: 10.1111/ijd.17918. Epub 2025 Jun 27.
The clinical implementation of optical coherence tomography (OCT) for diagnosing clinically equivocal lesions suspicious for basal cell carcinoma (BCC) is limited by an OCT assessor shortage. Cumulative sum (CUSUM) analysis enables monitoring of diagnostic performance during training. The objective was to evaluate whether CUSUM-integrated e-learning is suitable for training healthcare professionals in achieving and maintaining an acceptable error rate for differentiating BCC from non-BCC lesions on OCT. Furthermore, we explored the diagnostic accuracy of high-confidence BCC diagnoses by the newly trained assessors.
A CUSUM-integrated e-learning was developed. Trainee performance was monitored by CUSUM analysis. The number of OCT scans required to achieve and maintain a predefined acceptable error rate (percentage of correct diagnoses) was evaluated. Successfully trained assessors were asked to discriminate BCC from non-BCC on 100 OCT scans for a subsequent diagnostic accuracy study. Histopathology served as the reference standard.
Seventeen trainees successfully completed the training. Adequate performance was achieved and maintained after assessing a median of 385 scans (interquartile range [IQR]: 314-429). The pooled area under the curve (AUC) as measure for the ability to differentiate BCC from non-BCC lesions was 0.852 (95% confidence interval [CI]: 0.833-0.870). Pooled specificity and sensitivity for a high-confidence diagnosis were 95.4% (95% CI: 93.2-96.9) and 31.1% (95% CI: 24.2-39.0), respectively.
CUSUM-integrated e-learning was successfully applied to train healthcare professionals to differentiate BCC from non-BCC on OCT. Trainees achieved a diagnostic accuracy suitable to start using OCT in clinical practice. This method can be applied to overcome the OCT assessor shortage and for training other medical skills.
Clinicaltrials.gov: NCT05634421.
光学相干断层扫描（OCT）在临床诊断疑似基底细胞癌（BCC）的临床意义不明确的病变时，由于OCT评估人员短缺而受到限制。累积和（CUSUM）分析能够在培训期间监测诊断性能。目的是评估整合CUSUM的电子学习是否适合培训医疗保健专业人员，使其在OCT上区分BCC和非BCC病变时达到并维持可接受的错误率。此外，我们还探讨了新培训的评估人员对高置信度BCC诊断的诊断准确性。
开发了一种整合CUSUM的电子学习。通过CUSUM分析监测学员的表现。评估达到并维持预定义可接受错误率（正确诊断百分比）所需的OCT扫描数量。要求成功培训的评估人员在100次OCT扫描上区分BCC和非BCC，以进行后续的诊断准确性研究。组织病理学作为参考标准。
17名学员成功完成培训。在评估中位数为385次扫描（四分位间距[IQR]：314 - 429）后，达到并维持了足够的表现。作为区分BCC和非BCC病变能力指标的合并曲线下面积（AUC）为0.852（95%置信区间[CI]：0.833 - 0.870）。高置信度诊断的合并特异性和敏感性分别为95.4%（95%CI：93.2 - 96.9）和31.1%（95%CI：24.
