Non‐invasive, in vivo, characterization of cutaneous metastases using a novel multimodal RCM‐OCT imaging device: a case‐series

Abstract

Background Cutaneous metastases (CM) diagnosis is clinically challenging, requiring an invasive biopsy for confirmation. A novel, RCM‐OCT device combines the advantage of horizontal high‐resolution reflectance confocal microscopy (RCM) images and vertical deeper optical coherence tomography (OCT) images to aid in non‐invasive diagnosis of CM from breast cancers. Objective Characterize CM from breast cancers using RCM‐OCT device. Methods Seven patients suffering from breast cancers with suspicious CM were consented and imaged with RCM‐OCT device. CM features were defined by comparing with histopathology. Tumour depths were measured on OCT and on H&E‐images and correlated using statistical analysis Pearson test. 3D‐OCT images were reconstructed to enhance tumour visualization. Results 6/7 lesions were CM from breast cancers, and one was vascular ectasia, on histopathology. CM appeared as greyish‐darkish oval to round structures within the dermis on RCM and OCT‐images. On RCM, individual tumour cells were seen, enabling identification of even small tumour foci; while, on OCT deeper tumours were detected. Inflammatory cells, dilated vessels and coarse collagen were identified in the dermis. Pearson correlation had an r2 of 0.38 and a significant P‐value <0.004 for depth measurements. CM from breast cancers could be differentiated from ecstatic vessels on 3D‐reconstructed OCT image. Limitation Small sample size and lack of clinical mimickers. Conclusion RCM‐OCT can detect CM and has potential in aiding non‐invasive diagnosis and management.

Immediate diagnosis of cutaneous metastases with optical coherence tomography, line‐field confocal optical coherence tomography and dermoscopy: A case series

“…Farnetani et al showed that RCM can be used for the immediate diagnosis of melanoma metastases, 1 the described criteria were also visible in LC-OCT in the present study (Table 1). 1,2 Bang et al reported in a small case series signs of metastases of breast cancer in a RCM-OCT device. 2 Hyporeflective areas with clusters of hyporeflective cells surrounded by bundles of collagen fibres and inflammatory cells seem to be common findings of CM regardless of tumour entity.…”

“… 1,2 Bang et al reported in a small case series signs of metastases of breast cancer in a RCM–OCT device 2 . Hyporeflective areas with clusters of hyporeflective cells surrounded by bundles of collagen fibres and inflammatory cells seem to be common findings of CM regardless of tumour entity 1,2 . However, the visualization of pagetoid and dendritic cells in LC‐OCT might enable the immediate diagnosis of melanoma metastases.…”

“…Cutaneous metastases (CM) are a frequent finding in the follow-up of malignant tumours. 1,2 Optical coherence tomography (OCT) is a noninvasive imaging device that visualizes the skin up to a depth of 1.5 mm and the morphology of vessels with dynamic OCT (DOCT). 3,4 Linefield confocal OCT (LC-OCT) is a combination of OCT and confocal microscopy (CM) 5 that enables threedimensional imaging of the skin up to a depth of 0.5 mm at the cellular level.…”

“…Cutaneous metastases (CM) are a frequent finding in the follow‐up of malignant tumours 1,2 . Optical coherence tomography (OCT) is a noninvasive imaging device that visualizes the skin up to a depth of 1.5 mm and the morphology of vessels with dynamic OCT (DOCT) 3,4 .…”