<i><scp>I</scp>n vivo</i> confocal microscopy of basal cell carcinoma: a systematic review of diagnostic accuracy

Kadouch, Daniel J.; Schram, M.; Leeflang, Mariska; Limpens, Jacqueline; Spuls, Phyllis I.; Rie, Menno A. de

doi:10.1111/jdv.13224

Cited by 55 publications

(40 citation statements)

References 29 publications

(53 reference statements)

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“…The RCM features included: cord-like structures, tumor nests, palisading, streaming, dark peri-tumoral rim (clefting), stroma with plump cells and bright dots, and horizontal vessels, 13,14,16,27–29 while OCT features were: hyporeflective/gray structures attached to the dermal-epidermal junction (DEJ), disruption of the DEJ, hyporeflective/gray ovoid structures in the dermis, dark peri-tumoral rim (clefting), hyper-reflective peritumoral stroma, hyper-reflective streaks and branched vessels. 12,30–32 …”

Section: Methodsmentioning

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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Section: Methodsmentioning

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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“…Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) are non‐invasive imaging technologies capable to aid in the diagnosis of BCC, OCT with a reported sensitivity of 85–90% and a specificity of 60–70%, and RCM with a sensitivity of 98% and a specificity of 75% . Commercially available and frequently applied OCT device has a field of view of 6 × 6 mm with a resolution of <5 μm axial and <7.5 μm lateral and a penetration depth of 1–2 mm.…”

Section: Introductionmentioning

confidence: 99%

Basal cell carcinoma treated with combined ablative fractional laser and ingenol mebutate – an exploratory study monitored by optical coherence tomography and reflectance confocal microscopy

Banzhaf

Phothong

Suku

et al. 2019

Acad Dermatol Venereol

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Background Basal cell carcinomas (BCCs) have previously been treated off‐label with ingenol mebutate (IM). Ablative fractional laser (AFL) may improve efficacy of IM by increasing drug uptake in the tumour. Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) detect BCC non‐invasively. Our aim was to investigate BCC response and tolerability after combined AFL and IM treatment of low‐risk BCCs. Methods Twenty patients with histologically verified superficial (n = 7) and nodular (n = 13) BCCs were treated with combined fractional CO2‐laser (10 600 nm) and IM 0.015% or 0.05%, the concentration depending on anatomical location. BCC response was evaluated clinically, by OCT and RCM at day 29 and 90 after first treatment, and histologically at day 90. Treatment was repeated at day 29 if BCC persisted. Local skin reactions (LSRs) were assessed using LSR scale at all visits. Results At day 29, 18/20 patients received a second treatment due to residual BCC detected clinically, by OCT or RCM. OCT and RCM presented subclinical BCCs in five of 20 cases (25%). At day 90, overall histological cure rate was 70%, corresponding to clinical (65%) and OCT/RCM (60%) cure rates, and agreement between evaluation methods was substantial (kappa ≥ 0.796, P < 0.0001). Clearance rates were similar for sBCCs and nBCCs (P = 0.354) and for lesions treated with IM 0.015% and 0.05% (P = 0.141). LSRs were tolerable, but scarring was observed in the majority of cleared patients. Conclusion Two treatments of combined AFL and IM show potential to treat low‐risk BCCs with acceptable tolerability. OCT and RCM show promise to detect subclinical BCCs at short‐term follow‐up.

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“…A non‐invasive real‐time high‐resolution optical imaging modality such as reflectance confocal microscopy (RCM) offers a complementary approach: peri‐operative detection of margins directly on patients in vivo . RCM imaging diagnoses NMSCs in vivo with high sensitivity and specificity . Beyond diagnosis, we can detect margins, to potentially guide treatment and to augment the standard approaches of pathology.…”

Section: Introductionmentioning

confidence: 99%

Peri‐operative delineation of non‐melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video‐mosaicking

Flores

Yélamos

Córdova

et al. 2019

Acad Dermatol Venereol

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Background The surgical removal of non‐melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labour‐intensive and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re‐excisions. Reflectance confocal microscopy (RCM) with a new video‐mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real‐time, augmenting the traditional approaches of histopathology. Objective To assess a new peri‐operative RCM video‐mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo. Methods Thirty‐five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video‐mosaics. Two RCM evaluators read and assessed video‐mosaics, and subsequently compared to the corresponding Mohs frozen histopathology. Results Reflectance confocal microscopy videos and video‐mosaics displayed acceptable imaging quality (resolution and contrast), pre‐operatively in 32/35 (91%) NMSC lesions and intra‐operatively in 29/35 lesions (83%). Pre‐operative delineation of margins correlated with the histopathology in 32/35 (91%) lesions. Intra‐operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumour and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video‐mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter‐evaluator agreement (k = 0.59, P ≤ 0.0002). Conclusions Peri‐operative RCM video‐mosaicking of NMSC margins directly on patients may potentially guide surgery in real‐time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re‐excisions. Further testing in larger studies is needed.

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In vivo confocal microscopy of basal cell carcinoma: a systematic review of diagnostic accuracy

Cited by 55 publications

References 29 publications

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

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

Basal cell carcinoma treated with combined ablative fractional laser and ingenol mebutate – an exploratory study monitored by optical coherence tomography and reflectance confocal microscopy

Peri‐operative delineation of non‐melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video‐mosaicking

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