Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies.
- 作者列表："Freeman K","Dinnes J","Chuchu N","Takwoingi Y","Bayliss SE","Matin RN","Jain A","Walter FM","Williams HC","Deeks JJ
OBJECTIVE:To examine the validity and findings of studies that examine the accuracy of algorithm based smartphone applications ("apps") to assess risk of skin cancer in suspicious skin lesions. DESIGN:Systematic review of diagnostic accuracy studies. DATA SOURCES:Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, and online trial registers (from database inception to 10 April 2019). ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Studies of any design that evaluated algorithm based smartphone apps to assess images of skin lesions suspicious for skin cancer. Reference standards included histological diagnosis or follow-up, and expert recommendation for further investigation or intervention. Two authors independently extracted data and assessed validity using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2 tool). Estimates of sensitivity and specificity were reported for each app. RESULTS:Nine studies that evaluated six different identifiable smartphone apps were included. Six verified results by using histology or follow-up (n=725 lesions), and three verified results by using expert recommendations (n=407 lesions). Studies were small and of poor methodological quality, with selective recruitment, high rates of unevaluable images, and differential verification. Lesion selection and image acquisition were performed by clinicians rather than smartphone users. Two CE (Conformit Europenne) marked apps are available for download. SkinScan was evaluated in a single study (n=15, five melanomas) with 0% sensitivity and 100% specificity for the detection of melanoma. SkinVision was evaluated in two studies (n=252, 61 malignant or premalignant lesions) and achieved a sensitivity of 80% (95% confidence interval 63% to 92%) and a specificity of 78% (67% to 87%) for the detection of malignant or premalignant lesions. Accuracy of the SkinVision app verified against expert recommendations was poor (three studies). CONCLUSIONS:Current algorithm based smartphone apps cannot be relied on to detect all cases of melanoma or other skin cancers. Test performance is likely to be poorer than reported here when used in clinically relevant populations and by the intended users of the apps. The current regulatory process for awarding the CE marking for algorithm based apps does not provide adequate protection to the public. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42016033595.
目的: 检查基于算法的智能手机应用程序 (“应用程序”) 评估可疑皮肤病变皮肤癌风险的准确性的研究的有效性和结果。 设计: 诊断准确性研究的系统评价。 数据来源: Cochrane中心对照试验注册、MEDLINE、Embase、CINAHL、CPCI、Zetoc、Science Citation Index和在线试验注册 (从数据库开始到 2019 年 4 月 10 日)。 选择研究的资格标准: 任何设计的研究，评估基于算法的智能手机应用程序，以评估可疑皮肤癌的皮损图像。参考标准包括组织学诊断或随访，以及进一步调查或干预的专家建议。两位作者使用QUADAS-2 (诊断准确性研究的质量评估 2 工具) 独立提取数据并评估效度。报告每个app的敏感性和特异性估计值。 结果: 纳入 9 项研究，评估了 6 种不同的可识别智能手机应用程序。使用组织学或随访验证了 6 个结果 (n = 725 个病灶)，使用专家建议验证了 3 个结果 (n = 407 个病灶)。研究规模小，方法学质量差，有选择性招募，无法评价的图像率高，并有差异验证。病灶选择和图像采集由临床医生而不是智能手机用户进行。有两个CE (康力特Europenne) 标记的应用程序可供下载。SkinScan在一项单一研究 (n = 15，5 个黑色素瘤) 中以 0% 的灵敏度和 100% 的特异性评价了黑色素瘤的检测。在两项研究 (n = 252，61 个恶性或癌前病变) 中评估了SkinVision，并获得了 80% 的敏感性 (95% 置信区间 63% 至 92%) 对恶性或癌前病变的检出特异性为 78% (67% ~ 87%)。对照专家建议验证的SkinVision应用程序的准确性较差 (三项研究)。 结论: 目前基于算法的智能手机应用程序不能依赖于检测所有黑色素瘤或其他皮肤癌病例。当用于临床相关人群和应用程序的预期用户时，测试性能可能比此处报告的更差。目前授予基于算法的应用程序CE标记的监管程序没有为公众提供足够的保护。 系统评价注册: PROSPERO crd42016033595。
METHODS::Blue rubber bleb naevus syndrome (BRBNS) is an extremely rare venous malformation that often manifests as multiple haemangioma-like lesions in the skin and gastrointestinal tract. The drug sirolimus plays a key role in the signalling pathway of angiogenesis and subsequent development of BRBNS and its use has been described in several case reports. We present a case series of four patients with BRBNS who exhibited good treatment response to sirolimus. All four patients were administered oral sirolimus at doses of 1.0-1.5 mg/m2 /day with a target drug level of 5-10 ng/mL and median treatment duration of 20 months. All patients had a reduction in the size of the lesions and a normalization of coagulopathy with tolerable drug adverse reactions at follow-up. Sirolimus may be effective and safe in paediatric patients with BRBNS. Further prospective studies are suggested to evaluate the long-term effectiveness of this drug.
METHODS:BACKGROUND:Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. OBJECTIVE:To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. METHODS:A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. RESULTS:A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. LIMITATIONS:This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. CONCLUSION:The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.
METHODS::Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.