| 胡 婕,陈 伟,卢 平,于映红,何晓燕,李 灿.皮肤镜诊断脂溢性角化病与基底细胞癌的准确性及结果分析[J].,2020,(16):3176-3180 |
| 皮肤镜诊断脂溢性角化病与基底细胞癌的准确性及结果分析 |
| The Accuracy and Result Analysis of Dermoscopy in the Diagnosis of Seborrheic Keratosis and Basal Cell Carcinoma |
| 投稿时间：2020-02-23 修订日期：2020-03-18 |
| DOI：10.13241/j.cnki.pmb.2020.16.039 |
| 中文关键词: 基底细胞癌 脂溢性角化病 皮肤镜 组织病理 |
| 英文关键词: Seborrheic Keratosis Basal Cell Carcinoma Dermoscopy Pathology |
| 基金项目:卫生部医药卫生科技发展研究中心项目（W2016ZT0327）；四川省卫生和计划生育委员会科研项目（17PJ169） |
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| 中文摘要: |
| 摘要 目的：探讨皮肤镜诊断脂溢性角化病与基底细胞癌的准确性，参照现有诊断标准对结果进行分析。方法：收集临床诊断为脂溢性角化病和基底细胞癌的病例，参照目前的皮肤镜诊断标准对其作出诊断，并与组织病理结果相比较，分析皮肤镜诊断脂溢性角化病与基底细胞癌的价值，并分析脂溢性角化病和基底细胞癌的皮肤镜特征。结果：应用皮肤镜诊断脂溢性角化病的准确性为94.6%，灵敏度为95.8%，漏诊率为4.2%，特异性为90.0%，误诊率为10.0%，阳性预测值为97.2%，阴性预测值为85.7%。Kappa值为0.843，皮肤镜诊断与病理诊断有极佳的一致性（u=8.901，P＜0.001）。脂溢性角化病患者中出现频次较高的皮肤镜特征分别为乳黄色角栓或多发性粟丘疹样囊性结构（66.7%）、粉刺样开口（56.5%），其次是沟壑样结构（脑回样外观）（42.0%）。应用皮肤镜诊断基底细胞癌的准确性为83.3%，灵敏度为84.6%，漏诊率为15.4%，特异性为80.0%，误诊率为20.0%，阳性预测值为91.7%，阴性预测值为66.7%。Kappa值为0.609，皮肤镜诊断与病理诊断有高度的一致性（u=3.684，P＜0.001）。基底细胞癌患者中出现频次较高的皮肤镜特征分别为大的蓝灰色卵圆形巢（81.8%）、多发性蓝灰色小球（59.1%），然后是分支状毛细血管扩张（45.5%）。结论：皮肤镜是一种无创的可以显著提高脂溢性角化病与基底细胞癌确诊率的检查办法，但现有诊断标准还需不断改良和细化。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the accuracy of dermoscopy in the diagnosis of seborrheic keratosis and basal cell carcinoma, analyzed the results according to the existing diagnostic standards. Methods: To collect cases clinically diagnosed as seborrheic keratosis and basal cell carcinoma, made diagnosis according to the current diagnostic standard of dermoscopy and compared with histopathological results, analyzed the value of dermoscopy in the diagnosis of seborrheic keratosis and basal cell carcinoma, the characteristics of dermoscopy in seborrheic keratosis and basal cell carcinoma were analyzed. Results: The diagnostic accuracy of dermoscopy in seborrheic keratosis was 94.6%, the sensitivity was 95.8%, the missed diagnosis rate was 4.2%, the specificity was 90.0%, the misdiagnosis rate was 10.0%, the positive predictive value was 97.2% and the negative predictive value was 85.7%. The Kappa value was 0.843, dermoscopy diagnosis and pathological diagnosis had excellent consistency(u=8.901, P＜0.001). The high frequency dermoscopy features of patients with seborrheic keratosis were milky yellow horn thrombus or multiple miliary papule like cystic structure(66.7%), acne-like opening(56.5%), gully like structure(Appearance of gyrus) was next(42.0%). The diagnostic accuracy of dermoscopy in basal cell carcinoma was 83.3%, the sensitivity was 84.6%, the missed diagnosis rate was 15.4%, the specificity was 80.0%, the misdiagnosis rate was 20.0%, the positive predictive value was 91.7% and the negative predictive value was 66.7%. The Kappa value was 0.609, dermoscopy diagnosis and pathological diagnosis had excellent consistency(u=3.684, P＜0.001). The high frequency dermoscopy features of patients with basal cell carcinoma were large blue-gray oval nest(81.8%), multiple blue-gray spheres(59.1%), branching telangiectasia was next(45.5%). Conclusion: Dermoscopy is a noninvasive method that can significantly increase the diagnostic rate of seborrheic keratosis and basal cell carcinoma, but the diagnostic criteria still needs to be improved and refined. |
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