中华皮肤科杂志 ›› 2026, Vol. 59 ›› Issue (5): 436-442.doi: 10.35541/cjd.20260015

• 论著 • 上一篇    下一篇

反射式共聚焦显微镜联合皮肤镜对基底细胞癌的诊断价值评估

崔若然1，2    宁小荔3    杨俊刚3    李承旭3    常建民4    陈玉迪4   

  1. 1北京医院、国家老年医学中心，北京  100730；2中国医学科学院北京协和医学院，北京  100730；3中日友好医院皮肤科，北京  100029；4北京医院皮肤科，北京  100730
  • 收稿日期:2026-01-06 修回日期:2026-03-09 发布日期:2026-04-30
  • 通讯作者: 常建民 E-mail:changjianmin@medmail.com.cn
  • 基金资助:
    中央高水平医院临床科研业务费（BJ-2025-128）

Evaluation of the diagnostic value of reflectance confocal microscopy combined with dermoscopy for basal cell carcinoma

Cui Ruoran1,2, Ning Xiaoli3, Yang Jungang3, Li Chengxu3, Chang Jianmin4, Chen Yudi4   

  1. 1Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Beijing 100730, China; 2Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; 3Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China; 4Department of Dermatology, Beijing Hospital, Beijing 100730, China
  • Received:2026-01-06 Revised:2026-03-09 Published:2026-04-30
  • Contact: Chang Jianmin E-mail:changjianmin@medmail.com.cn
  • Supported by:
    National High Level Hospital Clinical Research Funding（BJ-2025-128）

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摘要： 【摘要】 目的 探讨皮肤镜与反射式共聚焦显微镜（RCM）单独或联合对基底细胞癌（BCC）的诊断价值。方法 本研究为一项诊断试验准确性研究，回顾性收集2022年5月至2025年3月就诊于中日友好医院皮肤科临床拟诊BCC的患者。所有患者均依次接受皮肤镜、RCM和组织病理学检查。以病理学结果为金标准，计算皮肤镜、RCM及二者联合诊断BCC的灵敏度、特异度、阳性预测值、阴性预测值及准确率；采用Kappa检验评估诊断与病理结果的一致性，并利用Wilcoxon符号秩和检验比较诊断置信度评分。结果 共纳入139例临床拟诊的BCC患者，病理确诊BCC 79例（56.83%），非BCC 60例（43.17%），包括34例（24.46%）良性非色素性肿瘤、12例（8.63%）良性色素性肿瘤、10例（7.19%）恶性非色素性肿瘤以及4例（2.88%）黑色素瘤。诊断一致性方面，皮肤镜、RCM及二者联合诊断与病理结果的Kappa值分别为0.704、0.769和0.898（均P < 0.001）。皮肤镜单独诊断BCC的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为89.87%、80.00%、85.54%、85.71%和85.61%；RCM单独诊断BCC的上述指标分别为84.81%、93.33%、94.37%、82.35%和88.49%；二者联合诊断BCC的上述指标均有所提升，分别为94.94%、95.00%、96.15%、93.44%和94.96%。皮肤镜和RCM单独诊断的置信度评分［M（Q1，Q3）］均为3（2，3）分，而二者联合诊断的置信度评分提升至3（3，3）分，高于皮肤镜和RCM单独诊断（Z = -4.99、-4.61，均P < 0.001）。结论 皮肤镜与RCM联合应用可显著提高BCC诊断的准确性、置信度及与病理结果的一致性，其诊断效能优于任一单独方法。联合策略有效整合了皮肤镜的宏观形态观察与RCM的细胞级分辨率，具有明确的互补价值，为临床实现BCC无创精准诊断提供了可靠依据。

关键词: 癌, 基底细胞, 皮肤镜检查, 反射式共聚焦显微镜, 联合诊断

Abstract: 【Abstract】 Objective To evaluate the diagnostic value of dermoscopy and reflectance confocal microscopy （RCM）, alone or in combination, for basal cell carcinoma （BCC）. Methods A diagnostic accuracy study was conducted. Patients with clinically suspected BCC were retrospectively collected from the Department of Dermatology, China-Japan Friendship Hospital between May 2022 and March 2025. All patients underwent sequential dermoscopy, RCM, and histopathological examination. Using histopathological findings as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of dermoscopy and RCM alone or in combination for diagnosing BCC were calculated. The agreement between each diagnostic method and histopathological results was assessed using the Kappa test, and diagnostic confidence scores were compared using the Wilcoxon signed-rank test. Results A total of 139 patients with clinically suspected BCC were included. Histopathological examination confirmed BCC in 79 cases （56.83%） and non-BCC in 60 cases （43.17%）. The 60 patients with non-BCC included 34 with benign non-pigmented tumors （24.46%）, 12 with benign pigmented tumors （8.63%）, 10 with malignant non-pigmented tumors （7.19%）, and 4 with melanomas （2.88%）. Using histopathological findings as the reference standard, the Kappa values for dermoscopy alone, RCM alone, and their combination were 0.704, 0.769, and 0.898, respectively （all P < 0.001）. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of dermoscopy alone for diagnosing BCC were 89.87%, 80.00%, 85.54%, 85.71%, and 85.61%, respectively; for RCM alone, the corresponding values were 84.81%, 93.33%, 94.37%, 82.35%, and 88.49%, respectively; dermoscopy in combination with RCM improved these metrics to 94.94%, 95.00%, 96.15%, 93.44%, and 94.96%, respectively. The diagnostic confidence score （M［Q1, Q3］） was 3 （2, 3） points for both dermoscopy alone and RCM alone, whereas their combination increased the score to 3 （3, 3） points, which was significantly higher than that of either dermoscopy or RCM alone （Z = ?4.99, ?4.61, respectively, both P < 0.001）. Conclusion The combined application of dermoscopy and RCM markedly improves the diagnostic accuracy, confidence, and agreement with histopathological findings for BCC, demonstrating superior diagnostic performance compared with either method alone. This integrated strategy effectively combines the macroscopic morphological assessment by dermoscopy with the cellular-level resolution of RCM, demonstrating definite complementary value and providing a reliable basis for non-invasive and precise diagnosis of BCC in clinical practice.

Key words: Carcinoma, basal cell, Dermoscopy, Reflectance confocal microscopy, Combined diagnosis

引用本文

崔若然, 宁小荔 杨俊刚 李承旭 常建民 陈玉迪. 反射式共聚焦显微镜联合皮肤镜对基底细胞癌的诊断价值评估[J]. 中华皮肤科杂志, 2026,59(5):436-442. doi:10.35541/cjd.20260015

Cui Ruoran, Ning Xiaoli, Yang Jungang, Li Chengxu, Chang Jianmin, Chen Yudi. Evaluation of the diagnostic value of reflectance confocal microscopy combined with dermoscopy for basal cell carcinoma[J]. Chinese Journal of Dermatology, 2026, 59(5): 436-442.doi:10.35541/cjd.20260015