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首页> 外文期刊>Journal of Rural and Remote Environmental Health >COMPARISON OF DIAGNOSTIC ACCURACY OF SKIN LESIONS BY GENERAL PRACTITIONERS AND SPECIALISTS
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COMPARISON OF DIAGNOSTIC ACCURACY OF SKIN LESIONS BY GENERAL PRACTITIONERS AND SPECIALISTS

机译：全科医生和专科医生对皮肤病变诊断准确性的比较

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Background: Skin cancer is an increasing problem in fair-skinned populations world-wide. In north Queensland the majority of skin cancer is managed initially by general practitioners (GPs). It is important that doctors are able to diagnose skin lesions accurately. There are limited studies comparing the diagnostic accuracy of GPs and specialists. The objective of this report is to compare diagnostic agreement based on histopathology between GPs and specialists. Methods: All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia were recorded between December 1996 and October 1999. Clinical diagnoses were recorded and compared to histological diagnoses. Positive predictive values (PPVs) and sensitivities were calculated for the clinical diagnoses and stratified by histological subtype. The results were then compared between the GPs and specialists. Results: A total of 193 doctors – 174 GPs and 19 specialists - were recorded in the database. Only one of the 19 specialists was a dermatologist. Of the 8,694 first excisions, 1443 lesions (16.6%) were treated by specialists, the rest by GPs. For basal cell carcinoma, positive predictive value was significantly higher for specialists compared to GPs (81.2% versus 70.6%, p<0.001). For squamous cell carcinoma, common naevi and seborrhoeic keratosis sensitivity was significantly higher for GPs than for specialists (42.2% versus 34.6%; p=0.005, 42.9% versus 30.5% p=0.036 and12.9% versus 4.3% p=0.018, respectively). Conclusions: In the present analysis, although specialists had higher accuracy in the diagnosis of basal cell carcinomas, GPs were more accurate in the diagnosis of squamous cell carcinoma, common naevi and seborrhoic keratosis. Overall there was little difference in the diagnostic performance between the two groups of doctors. These findings contrast with previous studies which have found the diagnostic performance of specialists to be superior to that of GPs. It is possible that this improved diagnostic performance may be a reflection of the higher caseload of skin cancer experienced by GPs in North Queensland
机译：背景：皮肤癌是全世界白皙人群中日益严重的问题。在昆士兰州北部，大多数皮肤癌最初由全科医生（GPs）管理。医生必须能够准确诊断皮肤病变，这一点很重要。比较GP和专家的诊断准确性的研究很少。本报告的目的是比较全科医生和专家之间基于组织病理学的诊断协议。方法：在1996年12月至1999年10月之间，记录了澳大利亚汤斯维尔/图林根州所有经切除并经组织学证实的皮肤癌。记录临床诊断并将其与组织学诊断进行比较。计算出临床诊断的阳性预测值（PPV）和敏感性，并按组织学亚型进行分层。然后将结果与全科医生和专家进行比较。结果：数据库中总共记录了193位医生-174位GP和19位专家。 19位专家中只有一位是皮肤科医生。在8694例初次切除中，有1443例（16.6％）病变由专家治疗，其余由GP进行。对于基底细胞癌，与GP相比，专家的阳性预测值显着更高（81.2％对70.6％，p <0.001）。对于鳞状细胞癌，GP的普通naevi和脂溢性角化病敏感性显着高于专家（分别为42.2％对34.6％; p = 0.005、42.9％对30.5％p = 0.036和12.9％对4.3％p = 0.018） ）。结论：在目前的分析中，尽管专家在诊断基底细胞癌方面具有更高的准确性，但GP在诊断鳞状细胞癌，普通痣和脂溢性角化病方面更为准确。总体而言，两组医生的诊断性能差异不大。这些发现与以前的研究相反，以前的研究发现专家的诊断性能优于GP。这种改善的诊断性能可能反映了北昆士兰州全科医生所患皮肤癌的病例增加

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