Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York.
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology and Skin Cancer Department, La Timone Hospital, Aix-Marseille University, Marseille, France.
Transplant Cell Ther. 2022 Jan;28(1):51.e1-51.e14. doi: 10.1016/j.jtct.2021.09.014. Epub 2021 Sep 24.
Reflectance confocal microscopy (RCM) allows noninvasive, real-time evaluation of the skin at a resolution akin to histopathology (HP), but its application in cutaneous graft-versus-host disease (GVHD) has not been extensively assessed. We describe RCM features of cutaneous GVHD including acute (aGVHD), late acute, chronic (cGVHD; sclerotic and nonsclerotic subtypes), and inactive GVHD and correlate RCM with same-site HP for a subset of patients. Thirty-two adult and pediatric allogeneic hematopoietic cell transplantation (allo-HCT) recipients with cutaneous GVHD received RCM imaging of ≥1 lesions (n = 44), 13 of which necessitated skin biopsy. RCM images were deidentified and assessed by 2 RCM experts blinded to clinical and HP findings to reach a consensus on the features and patterns of the inflammatory dermatoses. Major RCM features (present in ≥65% of lesional sites) and patterns were reported. To determine the correlation between RCM and HP, detection of cellular features and patterns of inflammatory dermatoses were compared using percent agreement and prevalence-adjusted, bias-adjusted kappa estimates. Seven patients with early or late aGVHD (7 lesions) had irregular honeycombing, spongiosis, dermoepidermal junction (DEJ) and dermal inflammation, and melanophages; those with early aGVHD also had hyperkeratosis, dilated vessels, and coarse connective tissue. Both groups had an interface dermatitis pattern. Eighteen patients with nonsclerotic cGVHD (24 lesions) had irregular honeycombing, spongiosis, DEJ and dermal inflammation, dilated vessels, coarse connective tissue, and interface and spongiotic dermatitis patterns. Three sclerotic patients with cGVHD (7 lesions) had irregular honeycombing, DEJ and dermal inflammation with an interface dermatitis pattern. Four patients with inactive GVHD (6 lesions) showed minimal inflammation. RCM and HP had similar detection rates for 6 of 13 features and overall patterns important for diagnosis in 2 patients with late aGVHD (2 lesions; 15%) and 10 with nonsclerotic cGVHD (11 lesions; 85%) necessitating skin biopsy. RCM can detect features commonly reported in cutaneous GVHD and is comparable to HP. Additional characterization of cutaneous GVHD by RCM may enable future use in diagnosing, monitoring, or predicting disease in real time.
反射共聚焦显微镜（RCM）可在类似组织病理学（HP）的分辨率下对皮肤进行非侵入性、实时评估，但尚未广泛评估其在皮肤移植物抗宿主病（GVHD）中的应用。我们描述了皮肤 GVHD 的 RCM 特征，包括急性（aGVHD）、晚期急性、慢性（cGVHD；硬化型和非硬化型亚型）和非活动性 GVHD，并将 RCM 与同一部位的 HP 进行了关联，对一部分患者进行了研究。32 名接受过同种异体造血细胞移植（allo-HCT）的成人和儿科患者出现皮肤 GVHD，对其 44 处病变中的至少一处进行了 RCM 成像，其中 13 处需要进行皮肤活检。RCM 图像经过去识别处理，由 2 名对临床和 HP 发现不知情的 RCM 专家进行评估，以就炎症性皮肤病的特征和模式达成共识。报告了主要的 RCM 特征（存在于≥65%的病变部位）和模式。为了确定 RCM 与 HP 之间的相关性，使用百分率一致性和调整了偏倚的 kapp 值估计，比较了对细胞特征和炎症性皮肤病模式的检测。7 名早期或晚期 aGVHD 患者（7 处病变）具有不规则蜂巢状、海绵状、表皮基底膜（DEJ）和真皮炎症以及黑素细胞；早期 aGVHD 患者还有角化过度、扩张血管和粗糙结缔组织。两组均具有界面性皮炎模式。18 名非硬化型 cGVHD 患者（24 处病变）具有不规则蜂巢状、海绵状、DEJ 和真皮炎症、扩张血管、粗糙结缔组织以及界面和海绵状皮炎模式。3 名硬化型 cGVHD 患者（7 处病变）具有不规则蜂巢状、DEJ 和真皮炎症，表现为界面性皮炎模式。4 名非活动型 GVHD 患者（6 处病变）显示出最小的炎症。RCM 和 HP 在 13 项特征中的 6 项和 2 例晚期 aGVHD（2 处病变；15%）和 10 例非硬化型 cGVHD（11 处病变；85%）患者的重要整体模式中具有相似的检测率，这些患者需要进行皮肤活检。RCM 可检测到皮肤 GVHD 中常见的特征，与 HP 相当。通过 RCM 对皮肤 GVHD 进行进一步特征描述，可能使其能够在实时诊断、监测或预测疾病方面得到应用。
