A pilot study of a combined dermoscopic-pathological approach to the telediagnosis of melanocytic skin neoplasms

ArticleinJournal of Telemedicine and Telecare 10(1):34-8 · February 2004with9 Reads
DOI: 10.1258/135763304322764176 · Source: PubMed
Abstract
We examined a combined (dermoscopic-pathological) approach to the telediagnosis of melanocytic skin lesions. A store-and-forward teleconsultation was simulated. Dermoscopic and histopathology images from 12 melanocytic lesions were stored in a telepathology workstation. A dermoscopy consultant, a histopathology consultant and an expert in dermoscopic-pathological correlation gave their diagnoses and comments on the images. The consensus diagnosis between two teleconsultants on the original histological slides was regarded as the gold standard. The diagnostic accuracy was 83% (including one false negative diagnosis of malignancy) for teledermoscopy and 100% for teledermatopathology. The combined approach detected one case that showed a much greater atypia on dermoscopy than on histopathology. In this case step-sections of the sample were deemed to be required for definite diagnosis. The combined approach was helpful in detecting macroscopic and microscope sampling errors of melanocytic lesions during teleconsultation.
    • "Dermoscopically equivocal pink lesions fall into a category of difficult to diagnose lesions that more commonly invoke the need for second expert opinion that is now possible through telemedicine store and forward technology [30,31]. Distant evaluation of equivocal skin lesions using digital dermoscopy images only in telemedicine settings may not provide enough information to make a safe diagnosis with high sensitivity while maintaining an equitable specificity [20][21][22]. Additionally, combined dermoscopy-RCM image evaluation of pink lesions at a distance is also limited due to the possibility to miss small clues in the image mosaics that can influence the diagnostic decision and confidence [14,15,17]. "
    [Show abstract] [Hide abstract] ABSTRACT: Solitary pink lesions in differential diagnosis with hypopigmented/amelanotic melanoma present a diagnostic challenge in daily practice and are regularly referred for second expert opinion. Reflectance confocal microscopy (RCM) has been shown to improve diagnostic accuracy of dermoscopically equivocal pink lesions. No studies have been performed to evaluate the effect of adding a second expert reader and automatic removal of lesions with discordant management recommendations and its potential effect on diagnostic sensitivity and final management of these lesions in retrospective or telemedicine settings.
    Full-text · Article · Sep 2016
    • "Files are then transmitted over telecommunication networks via e-mail or a specific web application. In 2003 a pilot study of the dermoscopicpathological approach using telediagnosis for melanocytic skin neoplasms revealed that the diagnostic accuracy reached 83% versus gold standard (conventional histopathological diagnosis by experts) (Ferrara et al., 2004). In a prospective analysis, where 60 patients were included in evaluating the role of teledermatology within a primary care system, the total agreement rate between live diagnosis and distant diagnosis was considered high, ranging from 86. 6% to 91.6%. "
    Full-text · Chapter · Mar 2011 · PLoS ONE
    • "Moreover, the existence of the so-called 'special sites' of MSN [8] clearly means that the location of the lesions is another important diagnostic criterion. In recent years, following the increasing use of dermoscopy (dermatoscopy, epiluminescence microscopy, skin surface microscopy) for the preoperative evaluation of MSN91011121314, several reports have shown the positive influence of the dermoscopic features on the histopathologic evaluation of MSN1516171819. These results emphasize the value in studying whether clinical history and clinical information would impact upon the histopathologic diagnosis in dermatopathology [20]. "
    [Show abstract] [Hide abstract] ABSTRACT: We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN). Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures. In D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23). Most diagnostic changes were in D2 (age/sex/location). The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.
    Full-text · Article · Jun 2009
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