Reflectance confocal microscopy diagnostic accuracy for malignant melanoma in different clinical settings: systematic review and meta‐analysis

Abstract

Background The diagnostic accuracy of reflectance confocal microscopy (RCM) of cutaneous malignant melanoma (MM) seems promising. However, clinical scenarios in which RCM is most useful are still to be established. Objectives To assess the diagnostic accuracy of RCM for MM diagnosis according to study design, lesion type and diagnostic modality. Secondary outcomes include a comparison with dermoscopy. Methods A systematic literature search was conducted on PubMed, Embase, Scopus and Cochrane Public Library Databases for English articles published prior to January 2019. Statistical analyses were conducted with Meta-Disc v. 1.4, STATA 14.0 software and the QUADAS-2 tool. Results A total of 32 studies (7352 lesions) were included in the meta-analysis. Pooled sensitivity and specificity resulted 92% (95% CI: 0.91-0.93) and 70% (95% CI: 0.69-0.71), respectively. According to study design, diagnostic sensitivity was high for all study types, confirming a lower specificity for prospective interventional studies. Diagnostic accuracy remained high for all lesion types, with the highest specificity obtained for consecutive lesions of 77% (95% CI: 0.75-0.78) vs. 65% (95% CI: 0.63-0.66) for lesions highly suspicious for MM. RCM diagnostic accuracy was superior to dermoscopy, most notably in terms of specificity of 56% (95% CI: 0.52-0.60) vs. 38% (95% CI: 0.34-0.42), respectively. Studies were generally assessed across all domains as low or unclear risk of bias with a mainly low concern regarding applicability of evidence. Publication bias was asymmetrical (11.2 AE 4.0; 95% CI 2.97-19.43; P < 0.01). Conclusions Independent of study design, RCM has a high diagnostic power for MM detection, and unnecessary excisions are reduced compared to dermoscopy. This reduction is most evident in non-decisional RCM scenarios and for lesions analysed at RCM consecutively compared to those selected highly suspicious for MM. However, the scarcity, heterogeneity and bias associated with the data in literature should be considered when interpreting present conclusions.

Emerging Minimally Invasive Technologies for the Detection of Skin Cancer

“…A more recent and larger systematic review of 7352 lesions reported a pooled sensitivity of 92% and specificity of 70% for the diagnosis of melanoma [25]. In the study, the diagnostic accuracy of RCM remained high regardless of the lesion type [25]. RCM was shown to be useful for the detection of amelanotic melanoma with poor dermoscopic features [26,27].…”

“…A systematic review of 909 lesions reported that RCM had a sensitivity of 93% and specificity of 76% for the diagnosis of melanoma [24]. A more recent and larger systematic review of 7352 lesions reported a pooled sensitivity of 92% and specificity of 70% for the diagnosis of melanoma [25]. In the study, the diagnostic accuracy of RCM remained high regardless of the lesion type [25].…”

Acute Radiation Dermatitis Evaluation with Reflectance Confocal Microscopy: A Prospective Study

“…RCM is widely used for melanoma non-melanoma skin cancer diagnostics [ 34 , 35 , 36 , 37 ] and treatment management [ 38 , 39 ]. RCM as an optical biopsy method is also used for inflammatory skin diseases diagnostics and treatment monitoring [ 23 , 24 , 40 ].…”

Reflectance Confocal Microscopy of Aging Skin and Skin Cancer

“…In the past few years, reflectance confocal microscopy (RCM) has been employed as a noninvasive technique to visualize the skin at quasi-histological resolution; it has also been used as an add-on tool in the diagnosis of skin cancer, as a second level of examination after dermoscopy, to improve diagnostic accuracy [9][10][11][12]. Additionally, due to the fact that RCM avoids skin biopsy, it has also been applied to the investigation of skin aging signs [13].…”