Does biopsy accurately assess basal cell carcinoma (BCC) subtype?

Genders, Roel E.; Kuizinga, Marti C.; Teune, T M; Kruijk, Monique van der; Rengen, Annik van

doi:10.1016/j.jaad.2015.10.025

Cited by 13 publications

(15 citation statements)

References 5 publications

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“…It occurred in 8% ( n = 6) of the cases in the present study, vs. 40% in the study by Genders and 17% in the study by Stiegel. 16 , 18 In three cases, the infiltrative subtype observed in the preoperative biopsy (along with nodular or superficial) was not seen in MMS, but only the nodular or superficial. There are two possible justifications for downstaging.…”

Section: Discussionmentioning

confidence: 88%

“… 15 , 16 , 34 However, as in the studies by Genders and Wolberink, size did not influence the change in tumor aggressiveness. 18 , 20 Moreover, recurrent tumors (despite the small sample size hindering comparison) and location did not influence changes in aggressiveness.…”

Section: Discussionmentioning

confidence: 93%

“…Genders et al conducted the only study in which the MMS block was completely sectioned and was not debulked, which allowed the observation of the largest possible tumor sample. 18 In daily practice, the block is not completely sectioned, as this increases the cost and, mainly, surgical time. Furthermore, the presence of some deep cuts representing 100% of the peripheral margin is sufficient to consider the margins free.…”

Section: Discussionmentioning

confidence: 99%

“…This variation in the classification of subtypes has already been evaluated in other studies, such as that by Genders et al, in which two dermatopathologists evaluated the MMS slides, with substantial agreement, similar to the present study. 18 …”

Section: Discussionmentioning

confidence: 99%

“…In 76% of the tumors ( n = 60), aggressiveness was the same in the preoperative biopsy and MMS, a finding consistent with most other studies. 16 , 18 , 27 …”

Section: Discussionmentioning

confidence: 99%

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Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery

Cerci

Kubo

Werner

2020

Anais Brasileiros de Dermatologia

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Background The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy. Objectives a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery. Methods Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery. Results The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases. Study limitations Retrospective nature, sample size, and biopsies performed by different professionals. Conclusions The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In 76% of the tumors ( n = 60), aggressiveness was the same in the preoperative biopsy and MMS, a finding consistent with most other studies. 16 , 18 , 27 …”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery

Cerci

Kubo

Werner

2020

Anais Brasileiros de Dermatologia

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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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