反射式共聚焦显微镜联合皮肤镜对黑素细胞痣的诊断价值评估

目的 评估皮肤镜与反射式共聚焦显微镜(RCM)单独或联合对黑素细胞痣的诊断价值.方法 收集临床拟诊黑素细胞痣的患者37例,对皮损先进行皮肤镜、RCM检查,再经组织病理学检查确诊.总结黑素细胞痣的影像学特征,计算不同检查诊断黑素细胞痣的敏感度、特异度、阳性预测值、阴性预测值、正确率,分析皮肤影像技术与组织病理学诊断的一致性.结果 皮肤镜和RCM检查结果示真皮内痣细胞的形态结构可分为两种:(a)真皮乳头层不融合、高折光、圆形的痣细胞,皮肤镜下表现为褐色或浅褐色均质模式,见于5处皮损;(b)真皮乳头内不规则、高折光的痣细胞团块,皮肤镜表现为鹅卵石模式或球状模式,见于31处皮损.在诊断黑素细胞痣方面,RCM结合皮肤镜的敏感度、特异度、正确率、阳性预测值、阴性预测值分别为91.7％、87.5％ 、90.9％ 、97.1％ 、70％,RCM为86.1％ 、75％ 、84％ 、93.9％ 、54.5％,皮肤镜为77.8％ 、87.5％ 、75％ 、96.3％ 、41.2％.除特异度与皮肤镜相同外,RCM结合皮肤镜的其他指标均高于二者单独应用;RCM敏感度、正确率、阴性预测值高于皮肤镜,特异度、阳性预测值低于皮肤镜.RCM结合皮肤镜或单用RCM与组织病理诊断结果之间差异无统计学意义(x2值分别为0.25、0.57,P值分别为0.63、0.45),Kappa值分别为0.72、0.53;皮肤镜与病理诊断结果之间差异有统计学意义(x2=5.81,P=0.012).结论 RCM联合皮肤镜较二者单独使用能更准确地诊断黑素细胞痣.

Diagnostic value of reflectance confocal microscopy combined with dermoscopy for melanocytic nevus

Objective To evaluate the diagnostic value of dermoscopy and reflectance confocal microscopy (RCM) alone or in combination for melanocytic nevus.Methods A total of 37 patients with clinically diagnosed melanocytic nevus were collected.Skin lesions were firstly examined by dermoscopy and RCM,then were resected to be subjected to histopathological examination for final diagnosis.The imaging features of melanocytic nevus were summarized.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of different skin imaging techniques were calculated,and the consistency was analyzed between skin imaging techniques and histopathological examination.Results Based on the dermoscopic and RCM findings,2 kinds of nevus cells with different morphological features were observed in the dermis of intradermal nevus.One kind of nevus cells was characterized by a nonfusional,highly-refractive round structure in the papillary dermis under RCM,and by a brown or light brown homogenous pattern under dermoscopy,which was observed in 5 skin lesions.The other kind of nevus cells appeared as irregular,highly-refractive cell clumps in the papillary dermis under RCM,and by a cobblestone or globular pattern under dermoscopy,which was observed in 31 skin lesions.For the diagnosis of melanocytic nevus,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of RCM combined with dermoscopy were 91.7％,87.5％,90.9％,97.1％ and 70％ respectively,those of RCM were 86.1％,75％,84％,93.9％ and 54.5％ respectively,and those of dermoscopy were 77.8％,87.5％,75％,96.3％ and 41.2％ respectively.All the diagnostic indices of RCM combined with dermoscopy were higher than those of RCM or dermoscopy alone,except that the specificity was equal to that of dermoscopy alone.RCM showed higher sensitivity,accuracy and negative predictive value,but lower specificity and positive predictive value compared with dermoscopy.There were no significant differences in the diagnostic yield in melanocytic nevus between RCM combined with dermoscopy or RCM alone and histopathological examination (x2 =0.25,0.57,P =0.63,0.45,Kappa value =0.72,0.53,respectively).However,a significant difference in the diagnostic yield in melanocytic nevus was observed between dermoscopy and histopathological examination (x2 =5.81,P =0.012).Conclusion RCM combined with dermoscopy shows higher diagnostic accuracy for melanocytic nevus compared with RCM or dermoscopy alone.