Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel2Dermatology Service, Memorial Sloan Kettering Cancer Center, New York.
Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
JAMA Dermatol. 2016 Mar;152(3):299-304. doi: 10.1001/jamadermatol.2015.4993.
Reflectance confocal microscopy (RCM), a cellular-level, in vivo imaging technique, may be potentially used for monitoring melanocytic neoplasms for microscopic stability vs changes over time.
To test feasibility of using RCM to track specific microscopic structures within nevi over 1 year.
DESIGN, SETTING, AND PARTICIPANTS: This was an observational study, a review of prospectively acquired RCM images, performed at a tertiary academic medical center. Seventeen patients were enrolled from adult patients presenting to pigmented lesion clinic; from each participant, 3 confirmed benign nevi were randomly selected from the upper and lower back and from the lower extremity.
Nevi underwent standardized RCM imaging at baseline and after 1 year.
We tested interobserver reproducibility in recognition of tissue anchors, RCM structures that can be identified at 2 time points. We used 2 tests to measure concordance between independent readers: (1) In the multiple choice matching test (n = 43 nevi), readers were shown a tissue anchor in a baseline RCM image (≤ 1 × 1-mm field-of-view) and asked to identify the same structure in 1 of 4 equally sized RCM images obtained from the same nevus at follow-up. (2) In the annotation test (n = 29 nevi), readers were shown a tissue anchor in a follow-up RCM image (≤ 1 × 1-mm field-of-view) and asked to annotate the corresponding location of this structure in the baseline RCM mosaic image (≤ 5 × 5-mm field-of-view) from the same nevus; good agreement was defined as annotations deviant by less than 10% of the mosaic's width.
In total, 17 patients (mean age, 45 years [range, 28-70 years]; 10 [59%] were women) contributed a total of 51 nevi, of which 44 nevi (86%) were used for the study. Images from 7 nevi (14%) were suboptimal in quality. Tissue anchors were identified at both time points in all 44 nevi. Selected tissue anchors were located at a mean depth of 54.3 µm; the most commonly selected anchors (37 of 44 images [84.1%]) were dermal papillae. In the multiple choice matching test, compared with a reference reader, 2 readers correctly matched baseline to follow-up tissue anchors in 40 of 43 nevi (93%; P < .01) and 42 of 43 nevi (98%; P < .01), respectively. In the annotation test, there was good agreement between 2 readers in all 29 cases (100%); the mean deviation was 2% (range, 0%-7.5%).
Precise longitudinal tracking of microscopic structures in melanocytic nevi using RCM is feasible.
反射共焦显微镜（RCM）是一种细胞水平的体内成像技术，可能可用于监测黑色素细胞肿瘤的微观稳定性与随时间的变化。
测试使用 RCM 来追踪 1 年内痣内特定微观结构的可行性。
设计、设置和参与者：这是一项在三级学术医疗中心进行的前瞻性 RCM 图像观察性研究。从色素病变诊所的成年患者中招募了 17 名患者；从每个参与者中，随机选择 3 个确认的良性痣，分别来自背部的上部和下部以及下肢。
痣在基线和 1 年后接受标准化的 RCM 成像。
我们测试了观察者在识别组织锚点方面的再现性，组织锚点是可以在 2 个时间点识别的 RCM 结构。我们使用 2 种测试来衡量独立读者之间的一致性：（1）在多项选择匹配测试（n=43 个痣）中，向读者展示基线 RCM 图像（≤1×1mm 视野）中的组织锚点，并要求读者在同一痣的 4 个同样大小的 RCM 图像中识别相同的结构之一在随访中获得。（2）在注释测试（n=29 个痣）中，向读者展示随访 RCM 图像（≤1×1mm 视野）中的组织锚点，并要求读者在同一痣的基线 RCM 镶嵌图像（≤5×5mm 视野）中注释此结构的相应位置；良好的一致性定义为注释的偏差小于镶嵌图宽度的 10%。
共有 17 名患者（平均年龄 45 岁[范围 28-70 岁]；10[59%]名女性）贡献了总共 51 个痣，其中 44 个痣（86%）用于研究。7 个痣（14%）的图像质量不佳。所有 44 个痣均在两个时间点识别到组织锚点。所选组织锚点位于平均深度 54.3µm；最常选择的锚点（44 个图像中的 37 个[84.1%]）是真皮乳头。在多项选择匹配测试中，与参考读者相比，2 名读者在 43 个痣中的 40 个（93%；P<.01）和 43 个痣中的 42 个（98%；P<.01）中正确匹配了基线与随访的组织锚点。在注释测试中，2 名读者在所有 29 例中均达成良好的一致性（100%）；平均偏差为 2%（范围 0%-7.5%）。
使用 RCM 对黑色素细胞痣内的微观结构进行精确的纵向追踪是可行的。
