文章：

反射共聚焦显微镜在皮肤癌诊断中发挥最大效益之处：意大利那不勒斯国家癌症研究所的经验

Where Reflectance Confocal Microscopy Provides the Greatest Benefit for Diagnosing Skin Cancers: The Experience of the National Cancer Institute of Naples

原文发布日期：22 May 2025

DOI: 10.3390/cancers17111745

类型: Article

开放获取: 是

英文摘要：

Background: Although complete excision of suspicious melanocytic lesions is mandatory, it carries the risk of unnecessary scarring on one hand and inadequate treatment of misdiagnosed lesions on the other.Objectives: We evaluated the sensitivity, specificity, and predictive value of reflectance confocal microscopy (RCM) in diagnosing pigmented lesions with clinically ambiguous features―the so-called “gray zone” ―and compared its performance with the more established technique of epiluminescence microscopy (ELM).Results: Between 2019 and 2020, a total of 2282 melanocytic lesions were assessed using both ELM and RCM. Histopathological diagnosis aligned with the ELM risk classification in 91.6% of melanocytic lesions, specifically in 92.0% of very-high-risk lesions, 88.5% of high-risk lesions, 66.3% of medium-risk lesions, 96.3% of low-risk lesions, and 98.0% of very low-risk lesions. Similarly, histopathological diagnosis of these lesions corresponded with the RCM risk assessment in 91.2% of cases, including 90.9% of very-high-risk lesions, 84.4% of high-risk lesions, 93.1% of medium-risk lesions, 90.5% of low-risk lesions, and 96.2% of very low-risk lesions.Conclusions: Although ELM is a valuable tool for increasing the efficacy of clinical diagnosis, its reliability decreases for a group of lesions that appear suspicious during clinical skin examination. RCM, as a newer technique, appears to improve malignancy detection in suspicious melanocytic lesions without requiring excision; its sensitivity and specificity remain high even in lesions classified by ELM as posing a medium risk of malignancy.

摘要翻译： 

背景：尽管对可疑色素性病变进行完整切除是必要的，但一方面存在造成不必要瘢痕的风险，另一方面也可能对误诊病变治疗不足。目的：我们评估了反射式共聚焦显微镜（RCM）在诊断具有临床不明确特征（即所谓“灰色区域”）的色素性病变中的敏感性、特异性及预测价值，并将其性能与更成熟的皮肤镜（ELM）技术进行比较。结果：2019年至2020年间，共有2282例色素性病变同时接受了ELM和RCM评估。组织病理学诊断与ELM风险分类的一致性在全部色素性病变中达91.6%，具体表现为：极高风险病变92.0%、高风险病变88.5%、中风险病变66.3%、低风险病变96.3%、极低风险病变98.0%。同样，这些病变的组织病理学诊断与RCM风险评估的一致性为91.2%，其中极高风险病变90.9%、高风险病变84.4%、中风险病变93.1%、低风险病变90.5%、极低风险病变96.2%。结论：尽管ELM是提高临床诊断效能的重要工具，但其对临床皮肤检查中表现可疑的病变组可靠性有所下降。RCM作为新兴技术，可在无需切除的情况下提高可疑色素性病变的恶性检测能力；即使在ELM归类为中风险恶性病变中，其敏感性和特异性仍保持较高水平。

原文链接：

Where Reflectance Confocal Microscopy Provides the Greatest Benefit for Diagnosing Skin Cancers: The Experience of the National Cancer Institute of Naples