Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.
Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
J Eur Acad Dermatol Venereol. 2017 Oct;31(10):1655-1662. doi: 10.1111/jdv.14335. Epub 2017 Jun 20.
A clear distinction between actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) cannot reliably be made by clinical and dermoscopic evaluation alone. Dynamic optical coherence tomography (D-OCT) is a novel angiographic variant of OCT that allows for non-invasive, in vivo evaluation of the cutaneous microvascular morphology.
To investigate the microvascular structures of AK, BD and invasive SCC using D-OCT in order to gain insights into the microvascular morphology of lesions in the spectrum of keratinocyte skin cancers.
Forty-seven patients with a total of 54 lesions (18 AK, 12 BD and 24 SCC) were included in the study. D-OCT still images of AK, BD and SCC at three predefined skin depths were prepared and randomized, creating a study set of 162 D-OCT images. Three observers performed blinded evaluations of the randomized study set assessing multiple parameters including the different types of vascular morphology. Non-blinded quantitative measurements of vascular diameter were also performed.
The blinded observer analysis suggests that D-OCT evaluation of the vascular morphology may aid in distinguishing AK, BD and SCC lesions. We identified two vascular shapes that presented significantly differently across the lesion types, namely 'blobs' and 'curves'. A strong presence of blobs at 300 μm skin depth was characteristically seen in a third of BD cases, while not or only slightly present in AK and SCC lesions. Vascular curves were predominantly present in AK lesions.
We identified various vascular D-OCT features that may aid in non-invasively differentiating subtypes within the keratinocyte skin cancer spectrum.
仅凭临床和皮肤镜评估，无法可靠地区分光化性角化病（AK）、鲍恩病（BD）和鳞状细胞癌（SCC）。动态光学相干断层扫描（D-OCT）是 OCT 的一种新型血管造影变体，可实现对皮肤微血管形态的非侵入性、体内评估。
使用 D-OCT 研究 AK、BD 和侵袭性 SCC 的微血管结构，以深入了解角质形成细胞皮肤癌谱中病变的微血管形态。
本研究纳入了 47 名患者共 54 处病变（18 处 AK、12 处 BD 和 24 处 SCC）。对 AK、BD 和 SCC 在三个预设皮肤深度的 D-OCT 静态图像进行准备和随机化，创建了一个包含 162 个 D-OCT 图像的研究集。三名观察者对随机研究集进行了盲法评估，评估了包括不同血管形态类型在内的多个参数。还对血管直径进行了非盲法定量测量。
盲法观察者分析表明，D-OCT 对血管形态的评估可能有助于区分 AK、BD 和 SCC 病变。我们确定了两种在病变类型之间表现出明显差异的血管形状，即“斑点”和“曲线”。BD 病例中有三分之一特征性地在 300μm 皮肤深度处存在大量斑点，而 AK 和 SCC 病变中不存在或仅轻微存在。血管曲线主要存在于 AK 病变中。
我们确定了各种血管 D-OCT 特征，这些特征可能有助于在角质形成细胞皮肤癌谱中无创区分亚型。
