皮肤镜对基底细胞癌鉴别诊断价值的初步研究  

Dermoscopy in the differential diagnosis of basal cell carcinoma： a preliminary study

作　　者：李薇薇[1] 涂平[1] 杨淑霞[1] 李航[1] 汪旸[1] 

机构地区：[1]北京大学第一医院皮肤性病科,100034

出　　处：《中华皮肤科杂志》2013年第7期480-484,共5页Chinese Journal of Dermatology

基　　金：卫生部临床学科重点项目（卫规财函[2007]353号）

摘　　要：目的探讨皮肤镜在基底细胞癌鉴别诊断中的应用价值。方法选取北京大学第一医院行皮肤镜检查并经病理确诊的基底细胞癌皮损为病例组，并随机选取色素程度和部位与基底细胞癌相似的其他色素性皮损作为对照组。以病理检查结果为金标准，用诊断试验方法评价皮肤镜诊断基底细胞癌的能力，计算提示黑素细胞性皮损的指征在基底细胞癌中的出现情况，并比较不同色素程度的基底细胞癌在皮肤镜下的差异。结果病例组86例，对照组68例。基底细胞癌皮肤镜经典诊断模式的灵敏度、特异度、阳性预测值、阴性预测值分别为98．84％、89．71％、92．39％、98．39％，Youden指数为0．88，与病理诊断的符合率94．81％。色素网、多发褐色至黑色小球或小点、毛囊口周围色素在黑素细胞性皮损中的比例显著高于基底细胞癌（P〈0．05），蓝白幕样结构见于61．63％的基底细胞癌。蓝黑色斑片和蓝白幕样结构在重色素组基底细胞癌中出现频率显著高于低色素组（P〈0．01）。结论皮肤镜诊断色素性基底细胞癌的经典模式在中国人群也显示出良好的诊断能力，研究提出的几个指征如周边色素栅状排列、周边色素加深、毛囊口周围色素加深或减退，在鉴别诊断中的价值尚需大样本研究证实。Objective To estimate the application value of dermoscopy in the differential diagnosis of basal cell carcinoma （BCC）. Methods Patients who underwent dermoscopic examination and had been definitely diagnosed by pathological examination in the Peking University First Hospital were enrolled in this study. In a blind study, dermoscopic images of 86 BCC lesions from 81 patients （case group） and 68 non-BCC hyperpigmented lesions with similar degree of hyperpigmentation and location from 61 patients （control group） were evaluated for features suggestive of BCC and melanocytic lesions. The diagnostic capability of dermoscopy in patients with BCC was evaluated by diagnostic test. Pathology served as the gold standard method for diagnosis. The frequency of features suggestive of melanocytic lesions was calculated in BCC lesions, and dermatoscopic findings were compared between heavily and lightly pigmented BCC lesions. Results The sensitivity, specificity, positive predictive value, negative predictive value of the classic dermoscopic pattern for the diagnosis of BCC were 98.84%, 89.71%, 92.39%, 98.39% respectively, with a Youden index of 0.88. The coincidence rate was 94.81% between pathologic and microscopic diagnosis. Pigment network, multiple brown to black globules^dots, pigmentation around hair follicle openings were observed more frequently in melanocytic lesions compared with BCC lesions （all P 〈 0.05）. Blue-whitish veil-like structures were observed in 61.63% of the BCC lesions. The presence of blue-black blotch and blue-whitish veil-like structures was significantly more frequent in heavily pigmented BCC lesions than in lightly pigmented BCC lesions （both P 〈 0.01）. Conclusions The classic dermoscopic pattern of BCC shows a favorable diagnostic capacity in Chinese population, large-scale studies are needed to estimate the value of some features proposed in this study, such as peripheral pigment in palisade arrangement, peripheral hyperpigmentation and hypo- or hyperpigmentation around hai

关 键 词：皮肤镜检查 癌 基底细胞 诊断 鉴别 

分 类 号：R739.5[医药卫生—肿瘤]