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目的家庭医生经常进行皮肤病变评估,但对于准确且自信地确定需要皮肤活检或专家转诊的皮肤病变仍缺乏必要培训。本文旨在对皮肤癌检测中的一种新型、简化的皮肤镜检查算法的诊断性能进行评估。方法在本横断面研究中,由参加皮肤镜检查课程的人员,采用分类融合皮肤镜算法(TADA)对50个皮肤病变的偏振皮肤镜检影像(27个恶性病变和23个良性病变)进行评估。TADA皮肤镜检查标准包括:结构紊乱(色素和/或结构的无组织或不对称分布),星芒图案,蓝黑色或灰色,白色结构,反向色素网、溃疡及血管。在基础皮肤镜检查培训1 d后开展本研究。必要时为其提供与触诊(坚硬、凹陷)有关的临床信息。结果在200例参课人员中,120例(60.0%)参加了本研究,包括64例(53.3%)皮肤科医生和41例(34.2%)基层医疗医生,其中19例(46.3%)为家庭医生。52例(43.3%)医生之前未接受过皮肤镜检查培训。结果显示,TADA诊断恶性皮肤病变的灵敏度和特异度分别为94.8%和72.3%。之前是否接受过皮肤镜检查培训、是否具有多年皮肤镜检查经验与诊断灵敏度(P值分别为0.13和0.05)或特异度(P值分别为0.36和0.21)无关;医生专业类型与诊断灵敏度无关(P=0.37),但皮肤科医生的诊断特异度高于非皮肤科医生(79%比72%,P=0.008)。结论 TADA对皮肤癌的诊断灵敏度较高,在进行基本指导后,可作为家庭医生检查皮肤病变的有用皮肤镜检查算法。
The intended GP routinely evaluates the skin lesions but still lacks the necessary training to accurately and confidently determine the skin lesions requiring skin biopsy or expert referral. This article aims to evaluate the diagnostic performance of a new and simplified dermatoscopy algorithm for skin cancer detection. Methods In this cross-sectional study, polarized dermal microscopy images of 50 skin lesions (27 malignant lesions and 23 benign lesions) were evaluated by the TDS examiner who participated in the dermatoscopy course . TADA dermatoscopy criteria include: structural disorders (unorganized or asymmetrical distribution of pigments and / or structures), asteroid patterns, blue-black or gray, white structures, retrograde nets, ulcers, and blood vessels. This study was conducted 1 day after basic dermoscopy training. If necessary, provide clinical information on palpation (hard, sunken). Results Of the 200 participants, 120 (60.0%) participated in the study, including 64 (53.3%) dermatologists and 41 (34.2%) primary care physicians, of whom 19 (46.3%) were family members Doctors. 52 cases (43.3%) had not received dermatoscopy training before. The results showed that the sensitivity and specificity of TADA in the diagnosis of malignant skin lesions were 94.8% and 72.3% respectively. Have you ever had a previous dermatoscopy test and have had years of experience in dermatoscopy not related to diagnostic sensitivity (P = 0.13 and 0.05) or specificity (P = 0.36 and 0.21, respectively); the type of medical professional is not related to the diagnostic sensitivity P = 0.37), the diagnostic specificity of dermatologists was higher than that of non-dermatologists (79% vs. 72%, P = 0.008). Conclusion TADA has a high sensitivity for the diagnosis of skin cancer. After basic instruction, TADA can be used as a useful dermatoscopy algorithm for examining skin lesions by family doctors.