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• W2891984918 abstract "To the Editor: Early detection and excision are important for optimizing melanoma patients' outcomes.1Glazer A.M. Rigel D.S. Winkelmann R.R. Farberg A.S. Clinical diagnosis of skin cancer: enhancing inspection and early recognition.Dermatol Clin. 2017; 35: 409-416Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Making diagnoses on the basis of morphologic characteristics is challenging and can result in potentially unneeded biopsies or, worse, missed melanomas.2Grin C.M. Kopf A.W. Welkovich B. Bart R.S. Levenstein M.J. Accuracy in the clinical diagnosis of malignant melanoma.Arch Dermatol. 1990; 126: 763-766Crossref PubMed Scopus (243) Google Scholar There is increasing interest in developing adjunctive tools that improve diagnostic accuracy.3Winkelmann R.R. Farberg A.S. Glazer A.M. et al.Integrating skin cancer-related technologies into clinical practice.Dermatol Clin. 2017; 35: 565-576Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Electrical impedance spectroscopy (EIS) has been shown to be highly sensitive in melanoma diagnosis.4Malvehy J. Hauschild A. Curiel-Lewandrowski C. et al.Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety.Br J Dermatol. 2014; 171: 1099-1107Crossref PubMed Scopus (123) Google Scholar The process of malignant transformation alters the electrical properties of cutaneous tissue—changes that are sensed by EIS. A low-voltage electrode is applied to the lesion; the resultant painless current propagates through the skin and is sensed by a receiving electrode on the same probe. The device generates a score of 0-10, corresponding to the different predictive values4Malvehy J. Hauschild A. Curiel-Lewandrowski C. et al.Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety.Br J Dermatol. 2014; 171: 1099-1107Crossref PubMed Scopus (123) Google Scholar for melanoma. Although an EIS device is Food and Drug Administration–approved and available (Nevisense, Scibase-AB, Stockholm, Sweden), little is known regarding how it affects clinicians' management of pigmented lesions. The goals of this study were to assess the impact of EIS results on clinicians' diagnostic accuracy and biopsy decisions. In total, 164 dermatology trainees completed an online survey presenting clinical images of 45 pigmented lesions (28 benign, 17 melanoma). For each image, respondents were asked if they would recommend biopsy on the basis of morphologic assessment alone, and then asked again once presented with the corresponding EIS score (along with positive and negative predictive values4Malvehy J. Hauschild A. Curiel-Lewandrowski C. et al.Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety.Br J Dermatol. 2014; 171: 1099-1107Crossref PubMed Scopus (123) Google Scholar). The proportion of clinical decisions for which the addition of EIS score altered the decision to biopsy was calculated. In addition, the sensitivity, specificity, and proportion of missed melanomas and benign biopsies were determined for morphologic assessment alone and for morphologic assessment plus EIS score. Significance testing was performed using McNemar test for categorical variables and paired t tests for continuous variables. Overall, 7380 clinical decisions (164 respondents × 45 lesions) were made on the basis of morphology alone and 7380 were made on the basis of morphology plus EIS score. The decision to biopsy was made in 4527 of 7380 cases on the basis of morphology alone and 4553 of 7380 cases on the basis of morphology plus EIS. The EIS results altered the individual biopsy decision in 24.3% of cases (Table I). The addition of the EIS score resulted in 402 fewer missed melanomas and a net decrease of 376 benign biopsies (P < .001, Table II). When including the EIS score, the mean sensitivity of respondents for ruling out melanoma increased from 80.7% to 95.2% (P < .001) and mean specificity from 50.4% to 58.6% (P < .001).Table IChange in clinical management (decision to biopsy) of pigmented lesions of 164 clinicians with the addition of electrical impedance spectroscopy score versus morphologic assessment of clinical image aloneLesion typeNo change in clinical management with EIS, n (%)EIS results altered management from biopsy to observation, n (%)EIS results altered management from observation to biopsy, n (%)Overall change in decision to biopsy, n (%)Benign, N∗Total number of clinical decisions made on benign lesions (obtained by multiplying number of survey respondents, 164, by the number of benign lesions in the study, 28). = 45923242 (70.6)863 (18.8)487 (10.6)1350 (29.4)Melanoma, N†Total number of clinical decisions made on malignant lesions (obtained by multiplying number of survey respondents, 164, by the number of malignant lesions in the study, 17). = 27882350 (84.3)18 (0.6)420 (15.1)438 (15.7)Overall, N‡Total number of clinical decisions made on benign and malignant lesions (obtained by multiplying number of survey respondents, 164, by the number of lesions included the study, 45). = 73805592 (75.7)881 (11.9)917 (12.4)1798 (24.3)EIS, Electrical impedance spectroscopy.∗ Total number of clinical decisions made on benign lesions (obtained by multiplying number of survey respondents, 164, by the number of benign lesions in the study, 28).† Total number of clinical decisions made on malignant lesions (obtained by multiplying number of survey respondents, 164, by the number of malignant lesions in the study, 17).‡ Total number of clinical decisions made on benign and malignant lesions (obtained by multiplying number of survey respondents, 164, by the number of lesions included the study, 45). Open table in a new tab Table IINumber of melanomas that would be missed and benign biopsies performed both clinically and with the addition of EIS results among 164 dermatology residents assessing 45 pigmented lesionsMelanoma lesion no.EIS scoreABCD features presentMelanomas missed without EIS, n (%)Melanomas missed with EIS, n (%)Net change in melanomas missed with addition of EIS, nP value∗McNemar test.47ABC2 (1.2)0 (0)–2.5056AB71 (43.3)8 (4.9)–63<.00189ABCD22 (13.4)1 (0.6)–21<.001104AB53 (32.3)33 (20.1)–20<.001148ABCD1 (0.6)1 (0.6)0>.80178ABC19 (11.6)3 (1.8)–16<.001196CD48 (29.3)9 (5.5)–39<.001224ABC3 (1.8)6 (3.7)+3.375267ABCD11 (6.7)2 (1.2)–9.004286CD75 (45.7)15 (9.2)–60<.001325ABC37 (22.6)16 (9.8)–21<.0013310ABC9 (5.5)2 (1.2)–7.039379ABCD1 (0.6)2 (1.2)+1>.80398BCD28 (17.1)2 (1.2)–26<.001406AC109 (66.5)23 (14.0)–86<.001436C48 (29.3)11 (6.7)–37<.001446ABCD0 (0)1 (0.6)+1>.80Total537 (19.3)135 (4.8)–402<.001Benign lesion no.EIS scoreABCD features presentBenign biopsies performed without EIS, n (%)Benign biopsies performed with EIS, n (%)Net change in benign biopsies with addition of EIS, nP value∗McNemar test.16AC46 (28.1)142 (86.6)+96<.00121C2 (1.2)1 (0.6)–1>.8034CD53 (32.3)102 (62.2)+49<.00165C29 (17.7)111 (67.7)+82<.00174BCD119 (72.6)124 (75.6)+5.40592ABCD81 (49.4)14 (8.5)–67<.001115ABCD150 (91.5)161 (98.2)+11.001123CD67 (40.8)22 (13.4)–45<.001134BC108 (65.8)120 (73.2)+12.023154AB97 (59.2)116 (70.7)+19<.001161ACD122 (74.4)40 (24.4)–82<.001182ACD138 (84.2)61 (37.2)–77<.001202C76 (46.3)22 (13.4)–54<.001213C34 (20.7)9 (5.5)–25<.001234ABD150 (91.5)151 (92.1)+1>.80242A65 (39.6)10 (6.10)–55<.001256ABC85 (51.8)149 (90.9)+64<.001274ABC128 (78.1)131 (79.9)+3.648292AC39 (23.8)6 (3.7)–33<.001301BC51 (31.1)10 (6.1)–41<.001311AC55 (33.5)10 (6.1)–45<.001340AC35 (21.3)2 (1.2)–33<.001355AC83 (50.6)135 (82.3)+52<.001361ABC125 (76.2)46 (28.1)–79<.001384CD32 (19.5)75 (45.7)+43<.001412ACD95 (57.9)17 (10.4)–78<.001420ABCD158 (96.3)102 (62.2)–56<.001452ABCD53 (32.3)11 (6.7)–42<.001Total2276 (49.6)1900 (41.4)–376<.001A, Asymmetry; B, border irregularity; C, color variegation; D, diameter ≥ 6nn; EIS, electrical impedance spectroscopy.∗ McNemar test. Open table in a new tab EIS, Electrical impedance spectroscopy. A, Asymmetry; B, border irregularity; C, color variegation; D, diameter ≥ 6nn; EIS, electrical impedance spectroscopy. A diagnostic device is only useful if it affects clinical management and improves accuracy. In this study, EIS score led to a change in the decision to biopsy in ∼25% of cases and improved diagnostic accuracy, resulting in fewer biopsies of benign lesions and more biopsies of melanomas, without significantly changing the total number of biopsies. A higher specificity was seen in this study compared with the EIS pivotal trial (58.6 vs 34.4%),4Malvehy J. Hauschild A. Curiel-Lewandrowski C. et al.Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety.Br J Dermatol. 2014; 171: 1099-1107Crossref PubMed Scopus (123) Google Scholar, 5Braun R.P. Mangana J. Goldinger S. French L. Dummer R. Marghoob A.A. Electrical impedance spectroscopy in skin cancer diagnosis.Dermatol Clin. 2017; 35: 489-493Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar which measured the specificity of the device alone. This suggests that respondents utilized the EIS information synergistically with the clinical image, rather than basing decisions solely on the EIS results. A limitation of this study was that additional clinical data, such as patient history, risk factors, and dermoscopic images, were not available to participants. In addition, as this study only included trainees, the results might not extrapolate to more experienced clinicians. EIS had a meaningful impact on the decision to biopsy pigmented lesions with atypical features. When combined with morphologic assessment, EIS score led to improved accuracy without significantly changing the overall biopsy rate." @default.
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• W2891984918 title "Assessment of clinician accuracy for diagnosing melanoma on the basis of electrical impedance spectroscopy score plus morphology versus lesion morphology alone" @default.
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