腫瘍診断能力は向上するのか—腫瘍の術前・術後診断についての検討—

Does Cliniciansʼ Diagnostic Accuracy for Skin and Subcutaneous Tumors Improve with Experience?: A Comparison of Preoperative and Postoperative Diagnoses

はじめに

　市中病院の形成外科において，皮膚・皮下腫瘍摘出術は大きな割合を占める手術であり，術前に正しい鑑別診断を行うことは重要である。著者は問診，視診，触診で術前診断を行い，検査や治療の方針を決定しているが，術中所見や病理組織学的所見と一致しない症例にしばしば遭遇した。よって，術前診断の的中率がどれほどであるのか，またそれが経験により向上するのかについて検討した。

　We investigated the accuracy of preoperative diagnoses of skin and subcutaneous tumors and whether these diagnoses improve with clinical experience. The accuracy of the preoperative diagnoses of such tumors in 1,003 cases we experienced across 5 years and 5 months was 81.1%. With the division of this study period into three parts, the accuracy values were 80.8%, 82.5%, and 80.9%, indicating that (i) there is a limit to the accuracy of preoperative (i.e., observation-alone) diagnoses of skin and subcutaneous tumors, and (ii) the diagnostic accuracy improves with experience. The percentages of cases in which malignancy was suspected preoperatively but the lesion was confirmed as benign during surgery were 2.9%, 2.4%, and 2.9% in the three respective study periods, suggesting that there is a risk of extensive resection when a biopsy is not performed. However, the respective percentages of patients in whom there was only a suspicion of malignancy preoperatively but malignancy was later confirmed were 2.3%, 0.8%, and 0.7%, which indicates that the potential to identify malignancies may increase with experience.