In vivo differentiation of common basal cell carcinoma subtypes by microvascular and structural imaging using dynamic optical coherence tomography

Abstract

The subtype of basal cell carcinoma (BCC) influences the choice of treatment. Optical coherence tomography (OCT) is a non-invasive imaging tool, and a recent development of an angiographic version of OCT has extended the application of OCT to image the cutaneous microvasculature (so-called dynamic OCT, D-OCT). This study explores D-OCT's ability to differentiate the common BCC subtypes by microvascular and structural imaging. Eighty-one patients with 98 BCC lesions, consisting of three subtypes: 27 superficial BCC (sBCC), 55 nodular BCC (nBCC) and 16 infiltrative BCC (iBCC) were D-OCT scanned at three European dermatology centres. Blinded evaluations of microvascular and structural features were performed, followed by extensive statistical analysis of risk ratio (RR) and multiple correspondence analysis. nBCC lesions displayed most characteristic structural and vascular features. Serpiginous vessels, branching vessels, vessels creating a circumscribed figure and sharply demarcated hyporeflective ovoid structures in the dermis were all associated with a higher risk of the subtype being nBCC. The presence of highly present lines and dark peripheral borders at the margin of ovoid structures was negatively associated with iBCC. Lastly, the finding of hyporeflective ovoid structures protruding from epidermis correlated with sBCC. We identified various microvascular and structural D-OCT features that may aid non-invasive identification of BCC subtypes. This would allow clinicians to individualize and optimize BCC treatment as well as aid follow-up of non-surgical treatment.

Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy

“…The confounding feature in cluster analysis for differential diagnoses of sBCC or nsBCC was the presence of coiled vascular morphology in 3 of the 13 sBCCs. As has been proven in a study of BCC subtypes with optical coherence tomography, 19% of sBCCs were associated with slight or highly present microvascular coil features[40]. Vascular morphology and diameters are complex to evaluate with RCM, and the integration of optical coherence tomography, another noninvasive tool, could assist in more precise in vivo diagnoses[40].…”

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

“…Optical coherence tomography images were evaluated for BCC morphology based on previously defined features including presence of dark tumour islands, clefting, surrounding bright halos, focal thinning of epidermis in relation to hyporeflective structures and non‐reflective cystic areas. Mean value of D‐OCT‐assessed blood flow was calculated by integrated Vivosight software in 50 μm horizontal sections from 150 to 1000 μm depth and vascular morphology rated as (i) mesh; (ii) branching; or (iii) no direction in D‐OCT images at 350–400 μm depth . Microvascular pattern and blood flow were assessed at baseline and day 90 by a blinded evaluator (MM).…”

Vascular morphology in normal skin studied with dynamic optical coherence tomography

“…D‐OCT images were obtained from clinically healthy skin, using the VivoSight Dx, Michelson Diagnostics, Kent, UK . It uses a four beam infrared laser light with a centre wavelength of 1305 nm, and an optical resolution of <7.5 μm lateral and <5 μm axial and creates images of 6 × 6 mm .…”

“…Technical aspects of D‐OCT and guidelines for image analysis have been described . The D‐OCT vascular morphology has primarily been studied in non‐melanoma skin cancer (NMSC), where vascular shapes and patterns were found to differ among keratinocyte skin cancers and within subtypes of basal cell carcinomas (BCC) . These studies have used regional controls of clinically uninvolved skin from the same patient, and normal variation of microvasculature in healthy controls’ skin has not previously been studied.…”