Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection.
Importance: Understanding the contribution of the ugly duckling sign (a nevus that is obviously different from the others in a given individual) in intrapatient comparative analysis (IPCA) of nevi may help improve the detection of melanoma.Objectives: To assess the agreement of dermatologists on ide...
| Publicado en: | JAMA Dermatology Vol. 153; no. 4; pp. 279 - 285 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
American Medical Association
Apr2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=122477154&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 122477154 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 21686068 FTFQ jtl: JAMA Dermatology issn: 21686068 maglogo: N pubinfo: dt: Apr2017 vid: 153 iid: 4 pid: 30 pub: American Medical Association place: Chicago, Illinois artinfo: ui: 122477154 122477154 NLM28196213 122477154 10.1001/jamadermatol.2016.5500 NLM28196213 122477154 ppf: 279 ppct: 6 formats: tig: atl: Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection. aug: au: Gaudy-Marqueste, Caroline Wazaefi, Yanal Bruneu, Yvane Triller, Raoul Thomas, Luc Pellacani, Giovanni Malvehy, Josep Avril, Marie-Françoise Monestier, Sandrine Richard, Marie-Aleth Fertil, Bernard Grob, Jean-Jacques affil: Dermatology and Skin Cancer Department, Hôpital Timone, Marseille, France sug: subj: Skin Neoplasms Diagnosis Melanoma Diagnosis Microscopy Methods Nevus Pathology Aged Sensitivity and Specificity Male Adult Middle Age Biopsy Young Adult Melanoma Pathology Observer Bias Female Diagnosis, Computer Assisted Methods Aged, 80 and Over Skin Neoplasms Pathology Scales Aged: 65+ years Adult: 19-44 years Middle Aged: 45-64 years Aged, 80 & over Male Female ab: Importance: Understanding the contribution of the ugly duckling sign (a nevus that is obviously different from the others in a given individual) in intrapatient comparative analysis (IPCA) of nevi may help improve the detection of melanoma.Objectives: To assess the agreement of dermatologists on identification of the ugly duckling sign and estimate the contribution of IPCA to the diagnosis of melanoma.Design, Setting, and Participants: The same 2089 digital images of the nevi of a sample of 80 patients (mean age, 42 years [range, 19-80 years]; 33 men and 47 women), as well as 766 dermoscopic images from a subset of 30 patients (mean age, 40 years [range, 21-75 years]; 12 men and 18 women), were randomly presented to the same 9 dermatologists for blinded assessment from September 22, 2011, to April 1, 2013. The first experiment was designed to mimic an IPCA situation, with images of all nevi of each patient shown to the dermatologists, who were asked to identify ugly duckling nevi (UDN). The second experiment was designed to mimic a lesion-focused analysis to identify morphologically suspicious nevi. Data analysis was conducted from November 1, 2012, to June 1, 2013.Main Outcomes and Measures: Number of nevi labeled UDN and morphologically suspicious nevi, specificity of lesion-focused analysis and IPCA, and number of nevi identified for biopsy.Results: Of the 2089 clinical images of nevi from 80 patients (median number of nevi per patient, 26 [range, 8-81]) and 766 dermoscopic images (median number of nevi per patient, 19 [range, 8-81]), all melanomas were labeled UDN and as morphologically suspicious nevi by the 9 dermatologists. The median number of UDN detected per patient was 0.8 among the clinical images of nevi (mean, 1.0; range, 0.48-2.03) and 1.26 among the dermoscopic images (mean, 1.4; range, 1.00-2.06). The propensity to consider more or fewer nevi as having ugly duckling signs was independent of the presentation (clinical or dermoscopic). The agreement among the dermatologists regarding UDN was lower with dermoscopic images (mean pairwise agreement, 0.53 for clinical images and 0.50 for dermoscopic images). The specificity of IPCA was 0.96 for clinical images and 0.95 for dermoscopic images vs 0.88 and 0.85, respectively, for lesion-focused analysis. When both IPCA and lesion-focused analyses were used, the number of nevi considered for biopsy was reduced by a factor of 6.9 compared with lesion-focused analysis alone.Conclusions and Relevance: Intrapatient comparative analysis is of major importance to the effectiveness of the diagnosis of melanoma. Introducing IPCA using the ugly duckling sign in computer-assisted diagnosis systems would be expected to improve performance. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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