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.

Autor: Yélamos O; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain. Electronic address: oyelamos@gmail.com., Manubens E; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain., Jain M; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Chavez-Bourgeois M; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain., Pulijal SV; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Dusza SW; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Marchetti MA; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Barreiro A; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain., Marino ML; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Malvehy J; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Barcelona, Spain., Cordova MA; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Rossi AM; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Rajadhyaksha M; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Halpern AC; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Puig S; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Barcelona, Spain., Marghoob AA; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Carrera C; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Barcelona, Spain. Electronic address: ccarrera@clinic.cat.
Jazyk: angličtina
Zdroj: Journal of the American Academy of Dermatology [J Am Acad Dermatol] 2020 Oct; Vol. 83 (4), pp. 1057-1063. Date of Electronic Publication: 2019 Jun 13.
DOI: 10.1016/j.jaad.2019.05.101
Abstrakt: 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.
(Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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