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

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. 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.

Impact of Electrical Impedance Spectroscopy on Clinician Confidence and Diagnostic Accuracy in Evaluating Melanocytic Skin Lesions Suspicious for Melanoma: A Pilot Study

“…EIS scores elevated the biopsy sensitivity of students close to that of dermatologists with images alone, suggesting particular value of EIS for novice diagnosticians. Moreover, this improvement in diagnostic accuracy among medical students is consistent with recent studies where the addition of EIS scores to clinical images alone increased diagnostic accuracy for novice diagnosticians, including trainees and midlevel practitioners [14][15][16] . Among the pigmented lesions specialists, the addition of an EIS score resulted in a trend toward improved accuracy of diagnosis, but it did not reach statistical significance.…”

“…The addition of EIS scores to clinical images resulted in more accurate biopsy decisionmaking by clinicians in survey studies. [14][15][16] . To date, however, the impact of EIS scores on clinician confidence in diagnosing lesions as benign or malignant remains unknown.…”

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

“…While Rocha et al (60) concluded that EIS could avoid the need for follow-up in 46.9% of suspicious benign lesions included in the study, Ceder et al (59) affirmed that no additional malignant lesions were found with EIS at t = 3, during follow-up procedure. A study (65) detailing the performance of a multitiered system of decision support system reported that the inclusion of the EIS score in clinical decision making led to a reduction in the number of unneeded biopsies and that the amount of the reduction depends on a clinician's experience, i.e., 14.8% for resident, 16.8% for midlevel, and 16% for practicing dermatologist. More recently, a paraelectric spectroscopy technology has been used for skin cancer application in a correlational study (64).…”

“…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.…”

Electrical impedance spectroscopy significantly enhances correct biopsy choice for pigmented skin lesions beyond clinical evaluation and dermoscopy

“…EIS technology has been validated for pre-biopsy assessment of cancerous and high-risk pigmented skin lesions (PSLs) in a large prospective, multicenter, blinded study with over 2,000 patients [2]. EIS and dermoscopy have both been demonstrated to improve the selection of PSLs for biopsy [3,4,5]. The purpose of this study was to investigate whether EIS technology can further improve correct biopsy choices beyond clinical and dermoscopic evaluation for melanoma (MM), severe dysplastic nevi (SDN) and benign PSLs.…”