Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:83

Article

Yelamos, Oriol^1,2  Manubens, Elena²  Jain, Manu¹  Chavez-Bourgeois, Marion²  Pulijal, Sri, V¹  Dusza, Stephen W.¹  Marchetti, Michael A.¹  Barreiro, Alicia²  Marino, Maria L.¹  Malvehy, Josep^2,3  Cordova, Miguel A.¹  Rossi, Anthony M.¹  Rajadhyaksha, Milind¹  Halpern, Allan C.¹  Puig, Susana^2,3  Marghoob, Ashfaq A.¹  Carrera, Cristina^1,2,3 

[1] Mem Sloan Kettering Canc Ctr, Dermatol Serv, Dept Med, New York, NY 10021 USA

[2] Univ Barcelona, Hosp Clin Barcelona, Inst Investigac Biomed August Pi & Sunyer, Dermatol Dept,Melanoma Unit, Barcelona, Spain

[3] Ctr Invest Red Enfermedades Raras CIBERER, Inst Carlos III, Barcelona, Spain

关键词: basal cell carcinoma;    diagnostic accuracy;    diagnostic confidence level;    management;    melanoma;    reflectance confocal microscopy;    skin cancer;   

DOI  :  10.1016/j.jaad.2019.05.101

来源: Elsevier

【 摘 要 】

Background: Reflectance confocal microscopy (RCM) allows accurate, noninvasive, in vivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown. Objectives: We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions. Methods: Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM. Results: We included 272 consecutive lesions from 226 individuals (mean age, 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P < .001) when RCM confirmed or changed the diagnosis. Lesion management changed in 33.5% cases after RCM (to observation in 51 cases and to biopsy/excision in 31 cases). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8% and 80%, respectively. Limitations: Small sample size, real-life environment, and different levels of expertise among RCM users. Conclusion: Physicians' diagnostic confidence and accuracy increased after RCM when evaluating equivocal tumors, frequently resulting in management changes while maintaining high diagnostic accuracy.

【 授权许可】

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