Cinotti Elisa, Singer Aurélie, Labeille Bruno, Grivet Damien, Rubegni Pietro, Douchet Catherine, Cambazard Frédéric, Thuret Gilles, Gain Philippe, Perrot Jean Luc
Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy.
Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.
JAMA Ophthalmol. 2017 Aug 1;135(8):845-851. doi: 10.1001/jamaophthalmol.2017.2019.
The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field.
To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors.
A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions.
Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM.
In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM.
Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.
结膜和睑缘肿瘤的临床诊断具有挑战性，新的非侵入性成像技术在该领域可能具有重要价值。
评估手持式活体反射共聚焦显微镜（IVCM）对睑缘和结膜肿瘤诊断的准确性。
于2011年1月2日至2016年12月31日在圣艾蒂安大学医院进行了一项前瞻性观察研究（2015年12月31日前纳入患者，2016年12月31日前进行随访）。共纳入278例连续的睑缘或结膜病变患者。结膜病变通过使用裂隙灯的传统临床检查和手持式IVCM进行诊断。通过组织病理学检查对155个经临床和/或IVCM检查怀疑为恶性的新生物进行最终诊断，这些新生物被切除，其余140个病变进行了12个月或更长时间的随访。
使用裂隙灯临床检查和手持式IVCM计算结膜和睑缘恶性肿瘤的敏感性、特异性、阳性和阴性预测值。
在278例患者中（136例[48.9%]为女性；平均[标准差]年龄为59[21]岁），分析共纳入166个睑缘病变和129个结膜病变。在155个经组织病理学诊断的切除新生物中，与使用裂隙灯进行的临床检查相比，IVCM对睑缘恶性肿瘤（98%对92%）和结膜恶性肿瘤（100%对88%）显示出更高的敏感性。IVCM对睑缘恶性肿瘤的特异性高于裂隙灯检查（74%对46%），但对结膜恶性肿瘤的特异性略低于裂隙灯检查（78%对88%）。对所有新生物（155个切除的和140个随访中的）的分析证实了临床检查和IVCM在诊断准确性上的这些差异。模仿恶性黑素细胞的高反射性朗格汉斯细胞的存在是IVCM误诊结膜恶性肿瘤的主要原因。
手持式IVCM可能是识别结膜恶性肿瘤的有用工具。需要进一步研究来证实该设备的有用性，并确定可以将朗格汉斯细胞与恶性黑素细胞区分开来的可能特征，以防止使用IVCM误诊黑色素瘤。
