Grading keratinocyte atypia in actinic keratosis: a correlation of reflectance confocal microscopy and histopathology

Abstract

Expert rater scan consistently distinguish different grades of cytological atypia. Non-invasive RCM data from in vivo imaging can be graded for keratinocyte atypia, comparable to histopathological grading.

Dermoscopic and Reflectance Confocal Microscopy Findings in Extra-genital HPV16-associated Pigmented Squamous Cell Carcinoma in situ

“…Pigmented SCCIS is a known melanoma-mimic, both clinically and dermoscopically (7)(8)(9)(10). RCM can be useful in establishing the specific bedside diagnosis of pigmented SCCIS and pigmented actinic keratosis in its various degrees of atypia (11). In the present case series, the RCM features of atypical and sometimes disarranged honeycomb pattern at the spinous-granular layers and small closely-set rings of bright basal cells around the dermal papillae were indeed commensurate with the diagnosis of pigmented SCCIS (12).…”

Use of reflectance confocal microscopy to evaluate 5‐fluorouracil 0.5%/salicylic acid 10% in the field‐directed treatment of subclinical lesions of actinic keratosis: subanalysis of a Phase III, randomized, double‐blind, vehicle‐controlled trial

“…10 Confirmation of cellular and histological changes that characterize both clinical and subclinical lesions with RCM supports the view that both types of lesions should be considered in AK treatment. 4,11 A recent study that examined the correlation between RCM and histopathology for the detection of keratinocyte atypia, a key parameter for AK grading and characterization, reported similar detection rates for both RCM and histopathology, and high concordance between the two techniques in terms of the grading of keratinocyte morphology. 4,11 A recent study that examined the correlation between RCM and histopathology for the detection of keratinocyte atypia, a key parameter for AK grading and characterization, reported similar detection rates for both RCM and histopathology, and high concordance between the two techniques in terms of the grading of keratinocyte morphology.…”

“…4 Characterization of AK lesions by RCM correlates well with those derived from conventional biopsy and histopathological examination, which remains the practical reference standard. 11 RCM has also been shown to enable monitoring of dynamic changes in the tissue following topical treatment with 5-FU 0.5%/salicylic acid 10%, even at subclinical level. 11 RCM has also been shown to enable monitoring of dynamic changes in the tissue following topical treatment with 5-FU 0.5%/salicylic acid 10%, even at subclinical level.…”

Reflectance confocal microscopy: a crucial role for actinic keratosis treatment monitoring

“…However, RCM definition of some parameters is subjective and not highly reproducible, such as the classification for dyskeratosis (atypical honeycomb). For this reason, probably the authors decided to evaluate its extent, and not the degree of atypia, that requires a more complex approach for classification or the generation of standards . Computer model may be used to non‐invasively evaluate keratinocyte populations as a quantitative morphometric diagnosis in skin cancer detection and evaluation of cytoarchitectural degree of disorder, to provide objective and quantitative data for dyskeratosis detection and quantification …”

“…For this reason, probably the authors decided to evaluate its extent, and not the degree of atypia, that requires a more complex approach for classification or the generation of standards. 2 Computer model may be used to non-invasively evaluate keratinocyte populations as a quantitative morphometric diagnosis in skin cancer detection and evaluation of cytoarchitectural degree of disorder, to provide objective and quantitative data for dyskeratosis detection and quantification. 3 On the other side, conventional histopathology has a greater cytologic resolution compared to RCM and makes easier the distinction from AKs and invasive forms even though RCM seems a promising tool for this differential diagnosis.…”