Michelson Diagnostics Ltd, Maidstone, Kent, U.K.
University Hospital Munich, Department of Dermatology, Munich, Germany.
Br J Dermatol. 2018 May;178(5):1102-1110. doi: 10.1111/bjd.16154. Epub 2018 Mar 25.
We previously described the principal results from an observational, prospective, multicentre, clinical trial of the diagnostic value of optical coherence tomography (OCT) for basal cell carcinoma (BCC) in a clinical setting. In this trial, much additional useful information was gathered that warranted further analysis, presented here.
To investigate the influence of candidate diagnostic criteria, OCT image quality, lesion location, and observer confidence and interobserver variability on the diagnostic performance of OCT, and to assess its potential use for diagnosis of BCC subtypes.
A total of 234 clinically unclear 'pink lesions' were evaluated in three steps: after clinical examination, after adding dermoscopy and after adding OCT. In addition to the diagnoses (including lesion subtype), observers recorded which of 15 diagnostic criteria the OCT image contained, their confidence in the diagnoses, the OCT image quality and the anatomical location of the lesion.
Diagnostic performance of OCT did not depend on the lesion's anatomical location. Good OCT image quality was correlated with improved diagnostic performance, but diagnostic performance for lesions with mediocre image quality was still better than by clinical and dermoscopic examination. The main reason for reduced image quality was superficial scales and crusting. Observer confidence in diagnosis was correlated with diagnostic performance. Interobserver diagnostic performance was consistently higher than clinical examination and dermoscopy across all sites. BCC subtype could be determined with moderate accuracy, but further independent image markers are required.
OCT is useful in the diagnosis of BCC.
我们之前描述了一项观察性、前瞻性、多中心临床试验的主要结果，该试验评估了光学相干断层扫描（OCT）在临床环境下对基底细胞癌（BCC）的诊断价值。在该试验中，收集了许多额外的有用信息，值得进一步分析，现呈现于此。
探讨候选诊断标准、OCT 图像质量、病变位置、观察者信心和观察者间变异性对 OCT 诊断性能的影响，并评估其在 BCC 亚型诊断中的潜在用途。
总共评估了 234 个临床不明确的“粉色病变”，分为三个步骤进行：临床检查后、加入皮肤镜检查后和加入 OCT 检查后。除了诊断（包括病变亚型）外，观察者还记录了 OCT 图像包含的 15 个诊断标准中的哪些标准、他们对诊断的信心、OCT 图像质量和病变的解剖位置。
OCT 的诊断性能不依赖于病变的解剖位置。良好的 OCT 图像质量与改善的诊断性能相关，但图像质量中等的病变的诊断性能仍优于临床和皮肤镜检查。图像质量下降的主要原因是表面鳞屑和结痂。观察者对诊断的信心与诊断性能相关。观察者间的诊断性能始终高于所有部位的临床检查和皮肤镜检查。BCC 亚型的诊断具有中等准确性，但需要进一步的独立图像标记物。
OCT 对 BCC 的诊断有用。
