Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
J Eur Acad Dermatol Venereol. 2018 Jul;32(7):1155-1163. doi: 10.1111/jdv.14716. Epub 2018 Jan 23.
Histological examination is the gold standard for actinic keratosis diagnosis; however, it is not always a feasible approach. Reflectance confocal microscopy (RCM) is a non-invasive technique that may be an alternative for monitoring actinic keratoses treatment response. Topical 5-fluorouracil is indicated for actinic keratosis multiple lesions and for field cancerization treatment.
To assess the RCM accuracy, sensibility and specificity for actinic keratosis, considering as a gold standard the histopathological examination; as well as to evaluate the efficacy of 5% 5-fluorouracil treatment.
This is a prospective study in actinic keratosis patients between August 2014 and November 2015. RCM analyses were performed in one randomly selected actinic keratosis lesion of the upper limbs by two independent observers before and after 5% 5-fluorouracil treatment. At the end of treatment and with clinical bleaching of treated lesions, histological examination was performed by two pathologists.
A total of 50 lesions were enroled, and 40 lesions presented complete clinical bleaching after treatment and were included in the final analysis. Accuracy, sensibility and specificity means among observers were 83.8%, 84.6% and 83.3%, respectively. After 5-fluorouracil treatment, actinic keratosis was diagnosed in 45.0% (observer 1) and 32.5% (observer 2) of subjects according to RCM and in 32.5% of subjects according to histological examination. Considering RCM observers diagnosis, the concordance was substantial (k 0.637, P < 0.001). 5-fluorouracil led to a reduction in 55.0%-67.5% of actinic keratoses according to RCM analysis.
This study allows to validate RCM as a non-invasive method capable of monitoring actinic keratosis therapeutic response to 5-fluorouracil, presenting efficacy comparable to histological examination. Additionally, the results suggest that 5-fluorouracil may be a satisfactory option for therapeutic control of this condition.
组织学检查是光化性角化病诊断的金标准；然而，它并不总是一种可行的方法。反射共聚焦显微镜（RCM）是一种非侵入性技术，可能是监测光化性角化病治疗反应的替代方法。外用 5-氟尿嘧啶适用于多灶性光化性角化病和区域性癌变治疗。
评估 RCM 对光化性角化病的准确性、敏感性和特异性，以组织病理学检查为金标准；并评估 5% 5-氟尿嘧啶治疗的疗效。
这是一项 2014 年 8 月至 2015 年 11 月期间光化性角化病患者的前瞻性研究。在 5% 5-氟尿嘧啶治疗前后，由两名独立观察者对上肢随机选择的一个光化性角化病病变进行 RCM 分析。治疗结束时，当治疗部位出现临床漂白时，由两名病理学家进行组织学检查。
共纳入 50 个病变，40 个病变在治疗后出现完全临床漂白，纳入最终分析。观察者之间的准确性、敏感性和特异性平均值分别为 83.8%、84.6%和 83.3%。根据 RCM，5-氟尿嘧啶治疗后，45.0%（观察者 1）和 32.5%（观察者 2）的受试者被诊断为光化性角化病，32.5%的受试者根据组织学检查被诊断为光化性角化病。根据 RCM 观察者的诊断，一致性很高（k 0.637，P<0.001）。根据 RCM 分析，5-氟尿嘧啶使 55.0%-67.5%的光化性角化病减少。
本研究验证了 RCM 作为一种非侵入性方法的有效性，能够监测 5-氟尿嘧啶治疗光化性角化病的疗效，其疗效与组织学检查相当。此外，结果表明 5-氟尿嘧啶可能是治疗这种疾病的一种令人满意的选择。
