Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial - 18/04/17
, Teresa Ojeda-Vila, MD, PhD a, Araceli Corrales, MD a, Francisco J. Martín-Gutiérrez, MD a, Andrés Ruíz-de-Casas, MD a, Rafael Galdeano, MD b, Ignacio Álvarez-Torralba, NP c, Francisco Sánchez-Ibáñez, NP c, José M. Domínguez-Toro, NP c, Fernando Encina, NP c, Francisco J. Narbona, MD b, Juan M. Herrerías-Esteban, MD d, David Moreno-Ramírez, PhD, MD aAbstract |
Background |
Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening.
Objective |
We sought to analyze the potential benefits gained from the addition of dermoscopic images to an internet-based skin cancer screening system.
Methods |
A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations.
Results |
A total of 454 patients were enrolled in the trial (nCTC = 226, nclinical with dermoscopic teleconsultation = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC (P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84).
Limitations |
Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation.
Conclusions |
The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.
Le texte complet de cet article est disponible en PDF.Key words : dermoscopy, information and communication technologies, melanoma, nonmelanoma skin cancer, pigmented lesions, seborrheic keratosis, teledermatology, teledermoscopy
Abbreviations used : CI, CTC, OR, TD
Plan
| The Impact of Teledermoscopy in Primary Care Skin Cancer Screening project is funded by a competitive grant obtained from the Health Council of the Regional Government of Andalusia-Spain (PI-0276-2013). |
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| Conflicts of interest: None declared. |
Vol 76 - N° 4
P. 676-682 - avril 2017 Retour au numéro
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