Chren M M, Lazarus H M, Bickers D R, Landefeld C S
Department of Dermatology (the Skin Diseases Research Center), University Hospitals of Cleveland and Case Western Reserve University School of Medicine, OH.
Arch Dermatol. 1993 Feb;129(2):175-81. doi: 10.1001/archderm.129.2.175.
Rashes in immunocompromised cancer patients can be important, and skin biopsies are often recommended for their evaluation. The objectives of this study were to determine how often skin biopsy in these patients is performed and how often it alters diagnosis and therapy. Records of all immunocompromised adults with cancer and acute rash seen by dermatology consultants on a hematology-oncology ward of a university hospital for 39 months were reviewed to determine patients' course and outcome (190 episodes of rash in 123 patients).
Skin biopsies were performed on 108 rashes (57%); 82 rashes (43%) were evaluated without biopsy. Among the 108 patients who underwent a biopsy of their rashes, the biopsy findings supported the prebiopsy diagnosis in 51% (95% confidence interval [CI], 42% to 60%), altered it in 44% (95% CI, 35% to 53%), and did not contribute to the final diagnosis in 6% (95% CI, 2% to 12%). Fifteen of 108 biopsies (14%) (95% CI, 7% to 21%) changed systemic therapy. Most treatment changes were for cutaneous reactions to drugs; biopsy never resulted in the diagnosis of untreated systemic infection. Biopsy findings that altered diagnoses were not more likely to change therapy. Among the 82 rashes in which biopsies were not performed, review of the chart revealed no adverse sequelae (0%) (95% CI, 0% to 5%), which would have made a biopsy advisable.
Skin biopsy findings often changed dermatologic diagnoses in immunocompromised cancer patients, but treatment changes based on biopsy results were much less common, and altered diagnoses in patients who underwent biopsy often did not change therapy. Untreated systemic infection was never diagnosed by means of a skin biopsy. Skin biopsies of these rashes may not be mandatory for either diagnostic or therapeutic reasons.
免疫功能低下的癌症患者出现皮疹可能较为重要，通常建议进行皮肤活检以评估病情。本研究的目的是确定这些患者进行皮肤活检的频率以及活检改变诊断和治疗的频率。回顾了一所大学医院血液肿瘤科病房的皮肤科会诊医生在39个月内诊治的所有免疫功能低下的成年癌症患者及急性皮疹的记录，以确定患者的病程和结局（123例患者出现190次皮疹发作）。
108次皮疹（57%）进行了皮肤活检；82次皮疹（43%）未进行活检就得到了评估。在108例接受皮疹活检的患者中，活检结果支持活检前诊断的占51%（95%置信区间[CI]，42%至60%），改变诊断的占44%（95%CI，35%至53%），对最终诊断无帮助的占6%（95%CI，2%至12%）。108次活检中有15次（14%）（95%CI，7%至21%）改变了全身治疗。大多数治疗改变是针对药物引起的皮肤反应；活检从未导致未治疗的全身感染的诊断。改变诊断的活检结果并不更可能改变治疗。在未进行活检的82次皮疹中，查阅病历显示无不良后果（0%）（95%CI，0%至5%），这表明活检并非必要。
皮肤活检结果常改变免疫功能低下癌症患者的皮肤科诊断，但基于活检结果改变治疗的情况要少得多，且接受活检患者的诊断改变往往并未改变治疗。从未通过皮肤活检诊断出未治疗的全身感染。出于诊断或治疗原因，对这些皮疹进行皮肤活检可能并非必需。
