Combined reflectance confocal microscopy-optical coherence tomography for delineation of basal cell carcinoma margins: an<i>ex vivo</i>study

Iftimia, Nicusor; Peterson, Gary; Chang, Ernest W.; Maguluri, Gopi; Fox, William J.; Rajadhyaksha, Milind

doi:10.1117/1.jbo.21.1.016006

Cited by 24 publications

(16 citation statements)

References 41 publications

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“…Differentiation between the several BCC subtypes was difficult; however, variants of OCT like HD-OCT and multi-beam swept source OCT (MSS-OCT) showed potential for clinical use (Boone et al 2012 ; Gambichler et al 2007 ; Meekings et al 2016 ). Moreover, many studies were performed to assess the surgical margins during Mohs surgery (Alawi et al 2013 ; Coleman et al 2014 ; Cunha et al 2011 ; Durkin et al 2014 ; Iftimia et al 2016 ; Maier et al 2014 ; Pelosini et al 2013 ; Pomerantz et al 2011 ; Wang et al 2013 ). Conventional OCT yielded to a sensitivity of 19% and specificity of 56%, whereas HD-OCT showed an improved sensitivity of 75% and a specificity of 64% (Cunha et al 2011 ; Maier et al 2014 ).…”

Section: Resultsmentioning

confidence: 99%

The clinical usefulness of optical coherence tomography during cancer interventions

Manen

Dijkstra

Boccara

et al. 2018

J Cancer Res Clin Oncol

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IntroductionTumor detection and visualization plays a key role in the clinical workflow of a patient with suspected cancer, both in the diagnosis and treatment. Several optical imaging techniques have been evaluated for guidance during oncological interventions. Optical coherence tomography (OCT) is a technique which has been widely evaluated during the past decades. This review aims to determine the clinical usefulness of OCT during cancer interventions focussing on qualitative features, quantitative features and the diagnostic value of OCT.MethodsA systematic literature search was performed for articles published before May 2018 using OCT in the field of surgical oncology. Based on these articles, an overview of the clinical usefulness of OCT was provided per tumor type.ResultsA total of 785 articles were revealed by our search, of which a total of 136 original articles were available for analysis, which formed the basis of this review. OCT is currently utilised for both preoperative diagnosis and intraoperative detection of skin, oral, lung, breast, hepatobiliary, gastrointestinal, urological, and gynaecological malignancies. It showed promising results in tumor detection on a microscopic level, especially using higher resolution imaging techniques, such as high-definition OCT and full-field OCT.ConclusionIn the near future, OCT could be used as an additional tool during bronchoscopic or endoscopic interventions and could also be implemented in margin assessment during (laparoscopic) cancer surgery if a laparoscopic or handheld OCT device will be further developed to make routine clinical use possible.

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Section: Resultsmentioning

confidence: 99%

The clinical usefulness of optical coherence tomography during cancer interventions

Manen

Dijkstra

Boccara

et al. 2018

J Cancer Res Clin Oncol

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“…Besides RCM, more and more studies are reporting on the added value of optical coherence tomography (OCT) for diagnosing and subtyping BCC . In addition, a first report on a combined RCM/OCT skin modality for ex vivo BCC detection has been published . This approach could potentially be of significant interest for diagnosing and subtyping BCC in clinical practice as it combines the detailed features of RCM with the in‐depth advantages of OCT.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of confocal microscopy imaging vs. punch biopsy for diagnosing and subtyping basal cell carcinoma

Kadouch

Leeflang

Elshot

et al. 2017

Acad Dermatol Venereol

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Background In vivo reflectance confocal microscopy (RCM) is a promising non‐invasive skin imaging technique that could facilitate early diagnosis of basal cell carcinoma (BCC) instead of routine punch biopsies. However, the clinical value and utility of RCM vs. a punch biopsy in diagnosing and subtyping BCC is unknown.ObjectiveTo assess diagnostic accuracy of RCM vs. punch biopsy for diagnosing and subtyping clinically suspected primary BCC.MethodsA prospective, consecutive cohort of 100 patients with clinically suspected BCC were included at two tertiary hospitals in Amsterdam, the Netherlands, between 3 February 2015 and 2 October 2015. Patients were randomized between two test‐treatment pathways: diagnosing and subtyping using RCM imaging followed by direct surgical excision (RCM one‐stop‐shop) or planned excision based upon the histological diagnosis and subtype of punch biopsy (standard care). The primary outcome was the agreement between the index tests (RCM vs. punch biopsy) and reference standard (excision specimen) in correctly diagnosing BCC. The secondary outcome was the agreement between the index tests and reference standard in correctly identifying the most aggressive BCC subtypes.ResultsSensitivity to detect BCC was similar for RCM and punch biopsy (100% vs. 93.94%), but a punch biopsy was more specific than RCM (79% vs. 38%). RCM expert evaluation for diagnosing BCC had a sensitivity of 100% and a specificity of 75%. The agreement between RCM and excision specimen in identifying the most aggressive BCC subtype ranged from 50% to 85% vs. 77% by a punch biopsy.ConclusionReflectance confocal microscopy and punch biopsy have comparable diagnostic accuracy to diagnose and subtype BCC depending on RCM experience. Although experienced RCM users could accurately diagnose BCC at a distance, we found an important difference in subtyping BCC. Future RCM studies need to focus on diagnostic accuracy, reliability and specific criteria to improve BCC subtype differentiation.

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“…We previously described a combined RCM-OCT bench-top instrument for ex vivo imaging of BCCs, 24 followed by a handheld probe for in vivo applications. 25 Here, we report a clinical study on testing the handheld probe on patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

et al. 2018

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IMPORTANCE The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs.OBJECTIVE To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. DESIGN, SETTING, AND PARTICIPANTSThis pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. MAIN OUTCOMES AND MEASURESImprovements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. RESULTSIn total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R 2 ) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 μm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 μm deep. CONCLUSIONS AND RELEVANCECombined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.

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Combined reflectance confocal microscopy-optical coherence tomography for delineation of basal cell carcinoma margins: anex vivostudy

Cited by 24 publications

References 41 publications

The clinical usefulness of optical coherence tomography during cancer interventions

The clinical usefulness of optical coherence tomography during cancer interventions

Diagnostic accuracy of confocal microscopy imaging vs. punch biopsy for diagnosing and subtyping basal cell carcinoma

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

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