104例皮膚鏡輔助診斷皮膚病的臨床分析

Clinical analysis on dermoscopy assisted diagnosis in 104 cases of skin disorders

楊聲顯(IEONG Seng hin)；梁雅晶(LEONG Nga cheng)；陳寶珊(CHAN Pousan)；曾翰翔(ZENG Hanxiang)；葉張章(YE Zhang-zhang)；吳俊傑(NG Chonkit)；曾婉君(CHANG Unkuan)；黃海山(WONG Hoishan)

皮膚鏡 ； 基底細胞癌 ； 鱗狀細胞癌 ； 癌前病變 ； 診斷標準 ； Dermoscopy ； Basal cell carcinoma ； Squamous cell carcinoma ； Cutaneous malignant tumors ； Diagnostic criteria

鏡湖醫學

21卷1期（2021 / 06 / 01）

56 - 59+i

繁體中文;英文

目的：評價應用便攜式皮膚鏡輔助診斷皮膚病的準確性及影響準確性的因素。方法：收集2019年7月～2020年4月在本院皮膚科門診及病房行病理活檢的皮膚病患者104例，1.以病理診斷為最終診斷結果，計算臨床診斷準確率和皮膚鏡診斷的準確率，並比較兩者的差異；2.以病程、性別、工作年期、活檢部位、疾病種類為分項變量，比較臨床診斷準確率與皮膚鏡診斷準確率的差異；3.計算皮膚惡性腫瘤指征診斷的靈敏度、特異度及Youden系數；4.以二項式廣義線性模型研究分項變量的交互作用對皮膚鏡診斷準確率的影響。結果：1.皮膚鏡診斷準確率較臨床診斷準確率高，醫生工作年期<15年組醫生組應用皮膚鏡後診斷準確率（84.4%）相當於工作年期≥15年組的臨床診斷準確率（82.5%）；2.皮膚鏡診斷皮膚惡性腫瘤指征的診斷標準以“異形血管＋特徵性結構”的特異度最高（98.9%）；3.在面頸部，皮膚鏡診斷皮膚惡性腫瘤的準確率較皮膚良性腫瘤及常見皮膚病高；應用皮膚鏡診斷皮膚惡性腫瘤，工作年期≥15年醫生組較<15年醫生組準確率高。結論：便攜式皮膚鏡輔助診斷皮膚病能提高對皮膚病診斷準確率，應用皮膚鏡診斷皮膚惡性腫瘤的特異性高，但受發病部位及醫生資歷影響。

Objective: To evaluate the accuracy of mobile dermoscopy assisted diagnosis for dermatosis and the factors affecting the accuracy. Methods: A total of 104 patients who underwent pathological biopsies in our dermatology clinic and ward from July 2019 to April 2020 were collected. (1) The accuracy of clinical diagnosis and dermoscopic diagnosis were calculated by using pathological diagnosis as the final diagnosis results, and the differences between them were compared. (2) The differences between clinical diagnosis accuracy and dermoscopic diagnosis accuracy were compared by using the course of disease, gender, working experience, biopsy site and disease type as subitem variables; (3) The sensitivity, specificity and Youden Index of indication diagnosis in cutaneous malignant tumors were calculated. (4) The binomial generalized linear model was used to study the influence of the interaction of subitem variables on the diagnostic accuracy of dermoscopy. Results: (1) The diagnostic accuracy of dermoscopy was higher than that of clinical diagnosis. The diagnostic accuracy of the group with working years <15 years was 84.4%, which was equivalent to that of the group with working years ≥15 years (82.5%). (2) The specificity of "abnormal blood vessel+characteristic structure" was the highest (98.9%) for the diagnostic criteria of dermoscopy for the diagnosis of cutaneous malignant tumors. (3) In the face and neck, the accuracy of dermoscopy in the diagnosis of dermoscopy was higher than that of benign epidermaltumors and common dermatosis; for the application of dermoscopy in the diagnosis of cutaneous malignant tumors, the accuracy was higher in the group with working years ≥15 years than in the group with working years <15 years. Conclusion: Mobile dermoscopy assisted diagnosis for improve the diagnostic accuracy rate of dermatosis. The specificity of dermoscopic diagnosis is high in cutaneous malignant tumors. The accuracy of dermoscopic diagnosis in cutaneous malignant tumors is affected by the position of the disease and the qualification of dermatologists.