Teledermatoscopia das lesões cutâneas pigmentadas

• Autor(a) principal: Ishioka, Priscila [UNIFESP]
• Data de Publicação: 2009
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://repositorio.unifesp.br/handle/11600/10105
• topic: Dermatoscopia; Lesões pigmentadas; Teledermatologia; Telemedicina; Pigmented skin; Teledermatology; Telemedicine; Dermatoscopy

Objectives: To evaluate agreement in diagnosis of pigmented skin lesions through presential or remote dermoscopic examination. To analyze diagnosis agreement of teledermoscopy and presential dermoscopic examination regarding pathological findings. To verify accuracy, sensibility and specificity of teledermoscopy in detection of malignant pigmented lesions. Methods: A total of 64 pigmented skin lesions were submitted to clinical and dermoscopic examinations performed presentially by two examiners experienced in dermoscopy, at the Dermoscopy Outpatient’s Clinic, Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), in 2005. Two years later, the digital clinical and dermoscopic images of these cases were re-examined by the same specialists through transmission of images and clinical data via web. Agreement between presential diagnosis and telediagnosis was assessed by the Kappa (κ) statistic calculation and its respective 95% confidence interval (95% CI). Through this calculation, the agreement between presential presumptive diagnoses and telediagnoses with pathological findings was analyzed. Sensitivity, specificity and accuracy of two diagnostic modalities were obtained using the pathological examination as the gold standard. The respective 95% confidence interval (95% CI) was calculated for each diagnostic measurement. Results: Good diagnostic agreement was observed between presential examination and teledermoscopy, with a Kappa value of 0.698 (95% CI - [0.575; 0.821]). Good agreement was also found between conventional examination and teledermoscopy, and the pathological findings (gold standard) had Kappa values of 0.728 (95% CI - [0.608; 0.848]) and 0.656 (95% CI - [0.526; 0.785]), respectively. Accuracy of 84%, sensitivity of 93% and specificity of 78% were observed in detecting malignant pigmented lesions by remote dermoscopic examination. Two false negative cases were observed through teledermoscopy. There was no statistically significant difference in sensitivity, specificity and accuracy of both diagnostic methods. Conclusions: Remote dermoscopic examination by means of digital image transmission and of clinical data provided diagnostic accuracy, sensitivity and specificity comparable to conventional examination. Teledermoscopy proved to be an efficient and reliable method to detect malignant lesions, representing an important tool to screen pigmented lesions. The good diagnostic agreement between assessment via web and conventional examination highlights the applicability of teledermoscopy as a specialized assistance tool in regions that are difficult to reach or lack health resources.