| Background and Objective Seborrheic Keratosis(SK),pigmented nevus are benign intraepidermal tumors.Clinical work for atypical clinical manifestations of SK,pigmented nevus lesions of the naked eye difficult diagnosis,missed diagnosis and misdiagnosis increased,and both are associated with the presence of melanoma,the correct diagnosis for the patient to choose the appropriate treatment,Improve patient quality of life.Clinically common diagnostic methods for histopathology,the technique for invasive examination,and may cause scarring,the risk of infection,difficult to be accepted by patients.Dermatoscopy,Reflection of confocal laser scanning microscopy(RCM)as the most widely used technique in the field of skin imaging,which can detect pathological changes of skin lesion in vivo,non-invasive,real-time and dynamic.The two techniques in the diagnosis of nevus and SK there are technical flaws,so the purpose of this study is to determine the dermatoscope combined with reflective confocal microscopy diagnosis of SK,whether benign and malignant pigmented nevus is better than a single imaging technology for diagnosis and pathology Diagnosis of the consistency of the results,and then analyze the joint use of the two technologies in the diagnosis of disease value.Materials and methods Collection of Hospital March 2016-November 2017 to be diagnosed as nevus,seborrheic keratosis patients,the number of lesions were 112 cases,168 cases.After the clinical diagnosis,the dermatoscope equipment was used to photograph the clinical picture,and the dermatoscope,RCM examination and corresponding parts were performed on the same lesion respectively to facilitate the later histopathological examination.The patient's imaging photos and save.Select the senior physicians,respectively,with reference to SK,dermatoscope nevus mole,RCM diagnostic criteria,diagnosis,dermoscopy and RCM imaging data are independent of each other,and ultimately the pathological results as the gold standard,diagnostic test research methods,Statistics of dermatoscope,RCM,dermoscopy + RCM three ways in the diagnosis of SK,nevus rate,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index,Kappa value,compared with the chi square test Pathological examination of the differences between the same time,compared the three methods of diagnosis of disease diagnosis accuracy is there any difference.Results:1.A total of 168 cases of skin lesions suspected to be diagnosed as SK were observed.Dermatoscopy was used to diagnose SK159 cases and non-SK9 cases.RCM was used to diagnose SK132 cases and non-SK36 cases.Dermatoscopy and RCM were used to diagnose SK160 and non-SK8 cases.The correct rate,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index and Kappa value of dermatoscopy in the diagnosis of seborrheic keratosis were 96.42%,96.93%,80%,3.06%,20%,76.93% and 0.554(P=0.219>0.05).The correct rate,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index of RCM in diagnosing SK were all considered to be statistically different between the two methods of dermoscopy and histopathology,Kappa values were 80.35%,80.98%,100%,19.01%,0,40.98%,0.202,respectively.It can be considered that the two methods of RCM and histopathology showed significant difference by chi-square test(P=0.0001<0.05).The correct rate,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index and Kappa value of dermatoscopy and RCM in diagnosis of SK were 97.62%,98.16%,100%,1.84%,0,78.2% and 0.76 That dermatoscopy + RCM diagnosis and histopathological diagnosis by chi-square test showed no significant difference(P= 0.25> 0.05).2.The lesions of 112 cases diagnosed as nevus were observed.There were 83 cases of benign lesions and 29 cases of malignant lesions diagnosed by dermoscopy;106 cases of benign lesions and 6 cases of malignant lesions were diagnosed by dermoscopy and RCM.The positive rate,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index and Kappa value of dermatoscopic diagnosis of nevi were 77.68%,76.85%,100%,0,23.15%,76.85% and 0.192,respectively.There was a statistically significant difference between the histopathological diagnosis of the mirror and the chi-square test(P=0.0001<0.05).The accuracy,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index and Kappa value of RCM in diagnosing nevi were 98.21%,98.14%,100%,0,1.85%,96.35% and 0.791,respectively;RCM Histopathology and Chi-square test showed no significant difference(P=0.5>0.05).The correct rate,sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden index and Kappa value of dermatoscopy + RCM in diagnosing nevi were 98.21%,98.14%,100%,0,1.85%,96.35%and0.791,respectively.Can be considered dermoscopy + histopathology and RCM two ways by chi-square test was no significant difference(P = 0.5> 0.05).3.Dermoscopy diagnosis of SK158 cases,non-SK10 cases;RCM diagnosis of SK132 cases,non-SK36 cases;dermoscopy + RCM diagnosis of SK161 cases,SK7 cases.Dermatoscope and RCM can be considered in the diagnosis of SK levels by chi-square test was significantly different(?2 = 20.503,P= 0.0001<0.0167);RCM and dermoscopy + RCM in two ways in the diagnosis of SK level The chi-square test showed significant difference(?2 = 22.628,P=0.0001<0.0167).There was no significant difference in the level of SK diagnosed by dermoscopy and dermoscopy + RCM(?2 = 0.062,P=0.803> 0.0167).4.Dermatoscopy diagnosis of benign 83 cases,29 cases of malignant;dermoscopy + RCM diagnosis of benign 106 cases,6 cases of malignant.There was a significant difference between the two methods in the diagnosis of SK by dermoscopy and dermoscopy + RCM(?2 = 17.913,P= 0.0001<0.0167).Conclusion: For seborrheic keratosis,the diagnosis of benign and malignant neoplasia,dermatoscopy + RCM diagnosis are superior to dermoscopy,RCM alone.For seborrheic keratosis,dermoscopy and RCM there are differences between the two in the clinical practice of the preferred choice of dermatoscope;For pigmented nevus,RCM is superior to dermoscopy,you can better understand Pathological changes of skin lesions.Choosing the right skin imaging technique for different diseases can save clinical costs and reduce unnecessary costs for patients. |
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