脂溢性角化症皮肤镜表现与病理特征的关系分析

Relationship between Dermatoscopy Manifestation and Pathological Features of Seborrheic Keratosis

目的:探讨脂溢性角化症(seborrheic keratosis,SK)皮肤镜表现与病理特征的关系。方法:选取2016年1月-2017年12月本院门诊临床拟诊为SK的66例患者,观察皮肤镜下表现及病理特点,分析不同皮肤镜表现与病理特点的关系。结果:66例患者通过皮肤镜检查诊断SK 58例(87.88%),通过病理检查确诊SK 59例(89.39%);以病理检查为金标准,皮肤镜检查诊断的灵敏度为93.22%(55/59),特异度为57.14%(4/7),诊断符合率为89.39%(59/66),误诊率为42.86%(3/7),漏诊率6.78%(4/59),Youden指数0.504,Kappa值为0.901(P=0.004);四种类型皮肤镜表现对应的病理类型各有不同,比较差异均有统计学意义(P<0.05)。结论:皮肤镜分型表现与病理特征具有较高的一致性,斑片型主要病理分型为角化型,天鹅绒样型主要病理分型为巢状型,疣状增生型主要病理类型为腺样型及刺激型,扁平丘疹型主要病理类型为棘层肥厚型。

Objective:To explore the relationship between dermatoscopy manifestation and pathological features of seborrheic keratosis(SK).Method:A total of 66 patients who were clinically diagnosed as SK in our outpatient clinic from January 2016 to December 2017 were selected.The dermatoscopy manifestation and pathological features were observed,and the relationship between different dermatoscopy manifestations and pathological characteristics were analyzed.Result:Among the 66 patients,58 cases(87.88%)were diagnosed as SK by dermatoscopy and 59 cases(89.39%)were diagnosed by pathology.With pathological examination as the gold standard,the sensitivity of dermatoscopy was 93.22%(55/59),the specificity was 57.14%(4/7),the total coincidence rate was 89.39%(59/66),the misdiagnosis rate was 42.86%(3/7),the missed diagnosis rate was 6.78%(4/59),the Youden index 0.504,and the Kappa value was 0.901(P=0.004).The pathological types of four types of dermatoscopy were different,the differences were statistically significant(P<0.05).Conclusion:Dermatoscopy manifestation and pathological characteristics has high consistency,patch type main pathological classification for diversification type,velvet sample main pathological classification of nests,verrucous hyperplasia type main pathological type is adenoid and nests,flat papules type main pathological types of stratum spinosum hypertrophic.