Assessment of clinician accuracy for diagnosing melanoma on the basis of electrical impedance spectroscopy score plus morphology versus lesion morphology alone

Svoboda, Ryan M; Prado, Giselle; Mirsky, Rachel; Rigel, Darrell S.

doi:10.1016/j.jaad.2018.08.048

Cited by 29 publications

(28 citation statements)

References 6 publications

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Early recognition and treatment of melanoma positively impacts outcomes and healthcare costs. [1][2][3][4] Significant heterogeneity exists with clinicians' ability to correctly assess the severity of pigmented lesions, leading to missed melanomas and unnecessary biopsies. 5 The number-ABSTRACT Introduction: The number-needed-to-biopsy (NNB) metric measures the efficiency of a clinician's ability to accurately diagnose and recommend pigmented skin lesions (PSLs) for biopsy for suspected melanomas.

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confidence: 99%

Integrating Electrical Impedance Spectroscopy into Clinical Decisions for Pigmented Skin Lesions Improves Diagnostic Accuracy: A Multitiered Study

Litchman

Marson²,

Svoboda

et al. 2020

J of Skin

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Introduction: The number-needed-to-biopsy (NNB) metric measures the efficiency of a clinician’s ability to accurately diagnose and recommend pigmented skin lesions (PSLs) for biopsy for suspected melanomas. Electrical impedance spectroscopy (EIS) is a non-invasive technique that measures differences in resistance between healthy and cancerous skin cells, intended as an aid to enhance diagnostic accuracy.Methods: Dermatology clinicians of three distinct groups (residents, physician assistants/nurse practitioners, and practicing dermatologists) were evaluated on their ability to accurately recommend suspect PSLs for biopsy before and after the integration of EIS data.Results: All three groups had a reduction in NNB after the inclusion of EIS. Instances of missed biopsies for malignant melanoma were significantly reduced with simultaneous significant reductions in unnecessary biopsies for benign lesions. There was a material improvement of biopsy selection for PSLs having clinically challenging features. EIS also greatly improved the diagnostic acumen of clinicians whose assessments were less accurate than their peers prior to EIS incorporation.Conclusions: The integration of EIS technology into the PSL biopsy decision was demonstrated to be effective in significantly enhancing clinician NNB and more accurate PSL biopsy selection.

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confidence: 99%

Integrating Electrical Impedance Spectroscopy into Clinical Decisions for Pigmented Skin Lesions Improves Diagnostic Accuracy: A Multitiered Study

Litchman

Marson²,

Svoboda

et al. 2020

J of Skin

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“…Higher scores indicate altered bioimpedance compared to within-patient control sites (11). EIS led to a change in a decision to biopsy lesions in 25% of cases, improved diagnostic accuracy, led to fewer biopsies of benign lesions and more biopsies of malignant lesions (54). It is currently unclear if EIS demonstrates altered signals in lesional HS tissue.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Non-invasive Imaging Modalities in Dermatological Disease: Potential Novel Biomarkers in Hidradenitis Suppurativa

2019

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Background: The development of imaging-based biomarkers has the potential to overcome major challenges in the accurate and reproducible assessment of disease severity and response to novel therapies in Hidradenitis Suppurativa (HS). Understanding the advantages and limitations of existing non-invasive imaging modalities in dermatological disease will aid in the development of hypotheses and inform the design of future studies.Methods: A scoping review was performed using Medline, Embase, Web of Science Databases and evaluation of “gray literature” until June 30, 2019. Citations were examined according to pre-defined inclusion and exclusion criteria. Citations were reviewed by two independent reviewers. Narrative Synthesis was used to summarize data, structured by imaging modality.Results: Non-invasive imaging modalities, such as ultrasound, MRI, RCM, EIS, OCT, and MIT, were identified. Only ultrasound, MRI and MIT have been used in HS. Image modalities vary in image depth, resolution, cost, accessibility and correlation with known aspects of disease activity in HS.Discussion and Conclusion: The benefits and limitations of each imaging modality are products of cost, accessibility, validity and reliability. An additional hurdle to the development of image-based biomarkers in HS is a lack of established analytical benchmarks that can be correlated with existing biological, inflammatory and clinical parameters. This review has identified potential imaging biomarkers, as well as relevant analytical benchmarks that reflect the presence or absence of disease. Further investigation work is needed to analytically and clinically validate these imaging variables in order to identify potential imaging biomarkers in HS.

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“…EIS studies employed the commercially-available Nevisense with a dedicated scoring system (57,58). However, it is unclear how this score is assigned to the investigated lesion, furthermore, most of the misdiagnosis were done on early-stage melanomas (58,63). A limitation of this technique is the need to take multiple measures of the same lesion, as the instrument's electrodes area does not cover the entire lesion.…”

Section: Discussionmentioning

confidence: 99%

“…For the EIS measurements, the majority of the studies employed the Nevisense system (56-60, 62, 63) (SCIBASE AB, Stockholm, Sweden), while only one study (61) used the Dermasense system. Three studies used the Nevisense to understand its efficacy (58,62,63) and safety (58), comparing the diagnostic performance of its decisional score system with the ABCD rule and the 7-point checklist. Gilou et al ( 61) collected only two measurements on one melanoma among their data.…”

Section: Skin Electrical Measurementsmentioning

confidence: 99%

“…Ceder et al (59) and Rocha et al (60) reported a specificity of 71% and 83%, respectively, employing the same technique in melanoma recognition. Recent studies (63,65) did not report TP, TN, FP, FN values and performance could not be analyzed. Ceder et al (59), with follow-up at 3 months, presented a sensitivity of 100% for a 70% specificity but the 95% CI were 3-100% and 48-89%, respectively.…”

Section: Studies Evaluationmentioning

confidence: 99%

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Comparative Analysis of Diagnostic Techniques for Melanoma Detection: A Systematic Review of Diagnostic Test Accuracy Studies and Meta-Analysis

et al. 2021

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Melanoma has the highest mortality rate among skin cancers, and early-diagnosis is essential to maximize survival rate. The current procedure for melanoma diagnosis is based on dermoscopy, i.e., a qualitative visual inspection of lesions with intrinsic limited diagnostic reliability and reproducibility. Other non-invasive diagnostic techniques may represent valuable solutions to retrieve additional objective information of a lesion. This review aims to compare the diagnostic performance of non-invasive techniques, alternative to dermoscopy, for melanoma detection in clinical settings. A systematic review of the available literature was performed using PubMed, Scopus and Google scholar databases (2010-September 2020). All human, in-vivo, non-invasive studies using techniques, alternative to dermoscopy, for melanoma diagnosis were included with no restriction on the recruited population. The reference standard was histology but dermoscopy was accepted only in case of benign lesions. Attributes of the analyzed studies were compared, and the quality was evaluated using CASP Checklist. For studies in which the investigated technique was implemented as a diagnostic tool (DTA studies), the QUADAS-2 tool was applied. For DTA studies that implemented a melanoma vs. other skin lesions classification task, a meta-analysis was performed reporting the SROC curves. Sixty-two references were included in the review, of which thirty-eight were analyzed using QUADAS-2. Study designs were: clinical trials (13), retrospective studies (10), prospective studies (8), pilot studies (10), multitiered study (1); the remain studies were proof of concept or had undefined study type. Studies were divided in categories based on the physical principle employed by each diagnostic technique. Twenty-nine out of thirty-eight DTA studies were included in the meta-analysis. Heterogeneity of studies' types, testing strategy, and diagnostic task limited the systematic comparison of the techniques. Based on the SROC curves, spectroscopy achieved the best performance in terms of sensitivity (93%, 95% CI 92.8–93.2%) and specificity (85.2%, 95%CI 84.9–85.5%), even though there was high concern regarding robustness of metrics. Reflectance-confocal-microscopy, instead, demonstrated higher robustness and a good diagnostic performance (sensitivity 88.2%, 80.3–93.1%; specificity 65.2%, 55–74.2%). Best practice recommendations were proposed to reduce bias in future DTA studies. Particular attention should be dedicated to widen the use of alternative techniques to conventional dermoscopy.

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Assessment of clinician accuracy for diagnosing melanoma on the basis of electrical impedance spectroscopy score plus morphology versus lesion morphology alone

Cited by 29 publications

References 6 publications

Integrating Electrical Impedance Spectroscopy into Clinical Decisions for Pigmented Skin Lesions Improves Diagnostic Accuracy: A Multitiered Study

Integrating Electrical Impedance Spectroscopy into Clinical Decisions for Pigmented Skin Lesions Improves Diagnostic Accuracy: A Multitiered Study

A Scoping Review of Non-invasive Imaging Modalities in Dermatological Disease: Potential Novel Biomarkers in Hidradenitis Suppurativa

Comparative Analysis of Diagnostic Techniques for Melanoma Detection: A Systematic Review of Diagnostic Test Accuracy Studies and Meta-Analysis

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