中华皮肤科杂志 ›› 2013, Vol. 46 ›› Issue (7): 480-484.

• 论著 • 上一篇    下一篇

皮肤镜对基底细胞癌鉴别诊断价值的初步研究

李薇薇1,涂平2,杨淑霞2,李航2,汪旸3   

  1. 1. 北京大学第三医院皮肤科
    2. 北京大学第一医院皮肤科
    3. 北京大学第一医院 皮肤性病科
  • 收稿日期:2012-08-13 修回日期:2012-09-03 出版日期:2013-07-15 发布日期:2013-07-01
  • 通讯作者: 涂平 E-mail:tup0207@sina.com

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

Weiwei LI1, 1, 1, Wang Yang1   

  • Received:2012-08-13 Revised:2012-09-03 Online:2013-07-15 Published:2013-07-01

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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。 【关键词】 皮肤镜检查； 癌，基底细胞； 诊断，鉴别

关键词: 癌，基底细胞, 皮肤镜检查, 诊断，鉴别

Abstract: LI Wei-wei, TU Ping, YANG Shu-xia, LI Hang, WANG Yang. Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China Corresponding author: TU Ping, Email: tup0207@sina.com 【Abstract】 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 hair follicle openings, in the differential diagnosis of pigmented diseases. 【Key words】 Dermoscopy; Carcinoma, basal cell; Diagnosis, differential

Key words: basal cell carcinoma