Binder M, Schwarz M, Winkler A, Steiner A, Kaider A, Wolff K, Pehamberger H
Department of Dermatology, University of Vienna Medical School, Austria.
Arch Dermatol. 1995 Mar;131(3):286-91. doi: 10.1001/archderm.131.3.286.
Epiluminescence microscopy (ELM) is a noninvasive technique that, by employing the optical phenomenon of oil immersion, makes subsurface structures of the skin accessible for in vivo examination and thus provides additional criteria for the clinical diagnosis of pigmented skin lesions. At present, almost all studies about the value and clinical importance of ELM are based on data derived from ELM experts (ie, dermatologists specifically trained in this technique). In the present study, we attempt to determine whether the clinical diagnosis of pigmented skin lesions is significantly improved using ELM and whether ELM-trained individuals and dermatologists not trained in this technique profit equally from this technique. Randomly selected histologically proven pigmented skin lesion specimens, photographed with (ELM) and without oil immersion (surface microscopy) were presented by slide projection to six ELM experts and 13 ELM nonexperts (ie, dermatologists not formally trained in ELM) for diagnosis. To evaluate the diagnostic performance of ELM experts and nonexperts with and without the oil immersion technique (ie, ELM vs surface microscopy), the following parameters were obtained: intraobserver and interobserver agreement by kappa statistics and sensitivity and specificity of diagnostic performance.
Our results show that by using the ELM technique the ELM experts reach a substantially better intraobserver agreement than nonexperts (median kappa, 0.56 vs 0.36). The interobserver agreement was markedly increased in the ELM experts group (average gain, 7%) but decreased in the ELM nonexperts group (average loss, 6%). The sensitivity of diagnosis was significantly increased in the ELM experts group (average gain, 10%), but decreased in the nonexperts group (average loss, 10%). Finally, the specificity of diagnosis was excellent in the ELM experts group, both with and without oil immersion (0.91) and was somewhat improved by ELM in the nonexperts group (0.77 vs 0.85).
We conclude that the ELM technique increases sensitivity in formally trained dermatologists, but may decrease the diagnostic ability in dermatologists not formally trained in the ELM technique. Consequently, formal broad-based training in ELM should be offered to the dermatologic community.
落射荧光显微镜检查（ELM）是一种非侵入性技术，它利用油浸光学现象，使皮肤的皮下结构能够进行体内检查，从而为色素性皮肤病变的临床诊断提供额外标准。目前，几乎所有关于ELM价值和临床重要性的研究都基于ELM专家（即接受过该技术专门培训的皮肤科医生）的数据。在本研究中，我们试图确定使用ELM是否能显著改善色素性皮肤病变的临床诊断，以及接受过ELM培训的人员和未接受过该技术培训的皮肤科医生是否能从该技术中同样获益。通过幻灯片投影向6名ELM专家和13名非ELM专家（即未接受过ELM正式培训的皮肤科医生）展示随机选取的经组织学证实的色素性皮肤病变标本，分别在有（ELM）和无油浸（表面显微镜检查）情况下拍摄的照片，以供诊断。为了评估ELM专家和非专家在有无油浸技术（即ELM与表面显微镜检查）下的诊断性能，获取了以下参数：通过kappa统计得到观察者内和观察者间的一致性以及诊断性能的敏感性和特异性。
我们的结果表明，使用ELM技术时，ELM专家的观察者内一致性明显优于非专家（中位数kappa，0.56对0.36）。ELM专家组的观察者间一致性显著提高（平均增益7%），而非ELM专家组则下降（平均损失6%）。ELM专家组的诊断敏感性显著提高（平均增益10%），而非专家组下降（平均损失10%）。最后，ELM专家组无论有无油浸，诊断特异性都很高（0.91），非专家组中ELM使其有所提高（0.77对0.85）。
我们得出结论，ELM技术提高了接受过正式培训的皮肤科医生的敏感性，但可能会降低未接受过ELM技术正式培训的皮肤科医生的诊断能力。因此，应向皮肤科界提供广泛的ELM正式培训。
