PDF(Pubmed)
Abstract：
Cutaneous melanoma (CM) is a candidate for screening programs because its prognosis is excellent when diagnosed at an early disease stage. Targeted screening of those at high risk for developing CM, a cost-effective alternative to population-wide screening, requires valid procedures to identify the high-risk group. Self-assessment of the number of nevi has been suggested as a component of such procedures, but its validity has not yet been established. We analyzed the level of agreement between self-assessments and examiner assessments of the number of melanocytic nevi in the area between the wrist and the shoulder of both arms based on 4548 study subjects in whom mutually blinded double counting of nevi was performed. Nevus counting followed the IARC protocol. Study subjects received written instructions, photographs, a mirror, and a \"nevometer\" to support self-assessment of nevi larger than 2 mm. Nevus counts were categorized based on the quintiles of the distribution into five levels, defining a nevus score. Cohen\'s weighted kappa coefficient (κ) was estimated to measure the level of agreement. In the total sample, the agreement between self-assessments and examiner assessments was moderate (weighted κ = 0.596). Self-assessed nevus counts were higher than those determined by trained examiners (mean difference: 3.33 nevi). The level of agreement was independent of sociodemographic and cutaneous factors; however, participants\' eye color had a significant impact on the level of agreement. Our findings show that even with comprehensive guidance, only a moderate level of agreement between self-assessed and examiner-assessed nevus counts can be achieved. Self-assessed nevus information does not appear to be reliable enough to be used in individual risk assessment to target screening activities.
摘要：
皮肤黑素瘤（CM）是筛查计划的候选者，因为当在疾病早期诊断时，其预后良好。有针对性地筛查那些发展为CM的高风险人群，一种具有成本效益的全人群筛查替代方案，需要有效的程序来识别高危人群。建议将痣数量的自我评估作为此类程序的组成部分，但其有效性尚未确定。我们根据4548名研究对象进行了相互盲的痣双重计数，分析了自我评估和检查者对腕部和双臂肩部之间区域的黑素细胞痣数量的评估之间的一致性水平。痣计数遵循IARC协议。研究对象收到书面指示，照片,一面镜子,和一个“nevometer”来支持对大于2毫米的nevi的自我评估。痣计数根据分布的五分位数分为五个级别，定义痣分数。估计科恩的加权卡帕系数(κ)来衡量一致性水平。在总样本中，自我评估和审查员评估之间的一致性中等(加权κ=0.596).自我评估的痣计数高于经过培训的检查者确定的痣计数（平均差：3.33痣）。协议水平独立于社会人口统计学和皮肤因素；然而，参与者的眼睛颜色对协议水平有显著影响。我们的研究结果表明，即使有全面的指导，只有在自我评估和审查员评估的痣计数之间达到中等程度的一致性。自我评估的痣信息似乎不够可靠，无法用于个人风险评估以针对筛查活动。
