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Reliability of quantification measures of actinic keratosis
S C Chen1, N D Hill, E Veledar
1Division of Dermatology, Department of Veterans Affairs Medical Center, Decatur, GA, U.S.A; Department of Dermatology, Emory University, Atlanta, GA, U.S.A.
Background:
Enumerating actinic keratoses (AKs) is highly variable but important to standardize as new therapies are emerging.
Objectives:
To assess the reliability of four different methods used to quantify AKs and to investigate whether a consensus meeting affects the reliability.
Methods:
This was a single-blinded study of 12 experienced dermatologist raters counting AKs on the face and ears of nine subjects before and after a consensus meeting. Raters were recruited from investigators of a multicentre Veterans Affairs cooperative study. The intraclass correlation coefficient (ICC) among raters for pre- and post-consensus evaluations was the primary outcome measure.
Results:
Of the four assessment methods, the 'total count' method had the greatest ICC for both pre- (0·18, P = 0·04) and post-consensus (0·66, P = < 0·0001) assessments. Total count was also the only pre-consensus ICC for which the null hypothesis of no association among assessments was rejected.
Conclusions:
Total AK count appears to be the most reliable measure of quantifying AKs on the face and ears. Educational consensus discussion prior to assessment improves reliability of this measure.
