Accuracy of clinical examination in the diagnosis of eyelid lesions

Abstract

Objective: To analyze the accuracy of the clinical examination in the diagnosis of eyelid lesions. Methods: From the observation of thirtyfive photos of benign and malignant eyelid tumors were presented to ophthalmologists, for each picture, it was asked 3 questions: 1) the lesion is malignant or not; 2) if considered malignant, the probably histological type; and 3) the tumor is aggressive or not. The phisicians were divided into 9 groups, according to academic degree (time since graduation and Oculoplastics specialty or not). Answers were compared with the results of the histopathologic study of the surgically resected tumor. Results: In total, one hundred and six ophthalmologists were interviewed. The professional experience influenced the diagnosis of malignancy of the tumor, as the Group 1 (first year residents) had the lowest accuracy (64.5%), with lower estimated agreement (kappa = 0.13), and Group 5 (graduated 5 years ago and with expertise in Oculoplastics) the highest accuracy (77.3%), with better agreement (Kappa = 0.45), and presented the best parameters for other analyzed items. For the histological type diagnosis, accuracy was lower: group 1 had the worst performance, with 51.1% accuracy, while the best was for group 6 (graduated over 5 years and with expertise in Oculoplastics, 77.2% ). As for the criterion of tumor aggressiveness, the results were closer among the different categories. Ophthalmologists trained longer and without expertise in Oculoplastics also showed a low diagnostic accuracy for malignancy and to determine the histological type of tumor. Conclusion: The low accuracy of clinical diagnosis of eyelid tumors in the groups above reinforces the need to improve ophthalmic oncology knowledge in these groups.