皮肤镜联合反射式共聚焦显微镜对色素痣良恶性、脂溢性角化病的诊断价值

Diagnostic value of reflectance confocal microscopy combined with dermoscopy on benign and malignant melanocytic nevus and seborrheic keratosis

目的:探讨皮肤镜联合反射式共聚焦显微镜(RCM)在诊断脂溢性角化病、色素痣良恶性方面是否优于单一影像技术。方法:收集中日友好医院皮肤性病科门诊2016年3月~2017年11月期间拟诊为色素痣、脂溢性角化病患者,皮损数量分别为112例、168例,经皮肤镜、RCM诊断后进行组织病理学检查确诊。分别计算皮肤镜、RCM、皮肤镜+RCM的诊断效能。结果:对于脂溢性角化病,皮肤镜诊断的正确率、灵敏度和特异度为96.42%、96.93%和80%,RCM为80.35%、80.98%和100%,皮肤镜+RCM为97.62%、98.16%和100%;皮肤镜显著优于RCM(P<0.05)。诊断色素痣良恶性,皮肤镜的正确率、灵敏度和特异度为77.68%,76.85%和100%,单用RCM和皮肤镜+RCM的正确率、灵敏度和特异度均为98.21%、98.14%和100%;RCM显著优于皮肤镜(P<0.05)。2种疾病采用3种检查的正确率与病理学诊断均无统计学差异(均P>0.05)。结论 :皮肤镜联合RCM的诊断效能优于单一影像技术。鉴别色素痣良恶性、脂溢性角化病首选检查分别为RCM、皮肤镜。

Objective：To investigate whether dermoscopy combined with reflectance confocal microscopy（RCM）is superior to each single imaging technique in the diagnosis ofseborrheic keratosis（SK）and benign or malignant nevus.Methods：A total of 112 patients with nevus and 168 patients with SK were enrolled in the Department of Dermatology of China-Japan Friendship Hospital from March 2016 to November 2017.After dermoscopic or RCM diagnosis,histopathological examination was performed.The diagnostic performance was calculated,respectively.Results：For SK,the accuracy,sensitivity and specificity of the dermoscopic diagnosis were96.42%,96.93% and 80%;RCM were 80.35%,80.98% and 100%;and dermoscopy＋RCM were 97.62%,98.16%and 100%.The results of dermoscopy were significantly better than those of RCM（P〈0.05）.For the diagnosis of benign and malignant nevus,the accuracy,sensitivity and specificity of dermoscopy were 77.68%,76.85% and100%.RCM alone and dermoscopy ＋RCM were all 98.21%,98.14% and 100%.RCM was significantly better than dermoscopy（P〈0.05）.For SK and nevus,there were no statistical differences between the correct rate and histopathological diagnosis among the 3 methods（all P〉0.05）.Conclusion：The diagnostic efficacy of dermoscopy combined with RCM is superior to that of each single and can provide more lesion information.The first choice for identification of benign or malignant nevus and SK is RCM and dermoscopy,respectively.