The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of nonpigmented basal cell carcinoma: an observational study

Abstract

has received speaker's honoraria from Almirall Hermal, Biofrontera, Galderma, Meda Pharma and JanssenCilag. C.B. has received speaker's and advisory board member's honoraria from, and has been involved in clinical trials sponsored by Almirall SummaryBackground The diagnostic criteria for basal cell carcinoma (BCC) using optical coherence tomography (OCT) have been described previously, but the clinical value of these findings remains unknown. Objectives To investigate the diagnostic value of OCT for BCC in a typical clinical setting. The primary efficacy end point was a diagnosis of BCC for each lesion. Secondary end points were the diagnosis of other possible conditions. Methods This was an observational, prospective, multicentre study in which consecutive patients with nonpigmented pink lesions suspicious for BCC underwent clinical assessment, dermoscopy and OCT, with the diagnosis recorded at each stage. Once all diagnoses had been recorded, the histological results were disclosed. In total 164 patients with 256 lesions were recruited. Histology was missing for 21 lesions, leaving 235 lesions in 155 patients for analysis. Results Sixty per cent of lesions (141 of 235) were identified as BCC by histology. A slight increase of sensitivity was noted following OCT, which did not reach statistical significance. The specificity increased significantly from 28Á6% by clinical assessment to 54Á3% using dermoscopy and to 75Á3% with the addition of OCT (P < 0Á001). The positive predictive value for the diagnosis of BCC using OCT was 85Á2% [95% confidence interval (CI) 78Á6-90Á4], and the negative predictive value was 92Á1% (95% CI 83Á6-97Á0). The accuracy of diagnosis for all lesions increased from 65Á8% with clinical evaluation to 76Á2% following additional dermoscopy and to 87Á4% with the addition of OCT. Conclusions OCT significantly improved the diagnostic specificity for BCC compared with clinical assessment and dermoscopy alone.

Vascular Features of Nail Psoriasis Using Dynamic Optical Coherence Tomography

“…OCT and RCM are relatively limited in depth penetration compared to HFUS. OCT has a penetration depth of up to 2 mm, while RCM achieves the least penetration depth of 250-350 µm, equivalent to the level of the papillary dermis and upper reticular dermis [14]. …”

Dynamic Optical Coherence Tomography in Dermatology

“…Combining major and minor OCT criteria for pattern analysis of the tissue enables diagnosis of BCC with a specificity of ∼75% and a sensitivity of ∼96% [2,7] and can also aid in the monitoring of medical treatments of BCC lesions [20,21,22]. An algorithm has been proposed for the subclassification of BCC using high-definition OCT but awaits further validation, while there is currently no data to suggest that standard OCT can reliably differentiate between BCC subtypes [5,23,24,25].…”

“…When added in the clinical diagnostic workflow of BCC, the additional use of OCT improved the diagnostic accuracy to 87.4%. In comparison, diagnostic accuracy for clinical assessment was 65.8 and 76.2% for dermoscopy, respectively [7]. …”

Imaging Blood Vessel Morphology in Skin: Dynamic Optical Coherence Tomography as a Novel Potential Diagnostic Tool in Dermatology

“…In dermatology, conventional OCT is mainly used and is already well established in the diagnosis of epithelial skin cancer such as basal cell carcinomas with good sensitivity (96%) and specificity (75%) [2]. Basal cell carcinomas show typical features such as ovoid ‘nests’ with a dark rim, and can be easily differentiated from actinic keratoses.…”