Department of Dermatology, University Hospital Tübingen, Eberhardt Karls University, Tübingen, Germany.
Clinic and Polyclinic for Dermatology, Venerology and Allergology, Leipzig, Germany.
Acta Derm Venereol. 2023 Mar 30;103:adv4859. doi: 10.2340/actadv.v103.4859.
Ex-vivo confocal laser scanning microscopy provides a rapid alternative to routine histological processing using haematoxylin and eosin-stained sections. Previous studies suggest high diagnostic accuracy in basal cell carcinoma. This study investigates the diagnostic accuracy of confocal laser scanning microscopy reporting of basal cell carcinoma in a real-life setting and compares reporting by dermatopathologists inexperienced in use of confocal laser scanning microscopy with reporting by an expert in confocal laser scanning microscopy. A total of 334 confocal laser scanning microscopy scans were diagnosed by 2 dermatopathologists inexperienced in the diagnosis of confocal laser scanning microscopy as well as an experienced examiner of confocal laser scanning microscopy scans. The inexperienced examiners achieved a sensitivity of 59.5/71.1% and specificity of 94.8/89.8%. The experienced examiner achieved a sensitivity of 78.5% and specificity of 84.8%. Detection of tumour remnants in margin controls showed insufficient values among inexperienced (30.1/33.3%) and experienced (41.7%) investigators. The results of this study, of real-life setting basal cell carcinoma reporting with confocal laser scanning microscopy, found a lower diagnostic accuracy than published data regarding artificial settings. A poor accuracy in tumour margin control is clinically relevant and could restrict the use of confocal laser scanning microscopy in clinical routine. Prior knowledge of haematoxylin and eosin trained pathologists can be partially transferred to the reporting of confocal laser scanning microscopy scans; however, specific training is recommended.
共对 334 个激光共聚焦扫描显微镜扫描图像进行了诊断，由 2 名未经验证的皮肤科病理学家以及一名经验丰富的激光共聚焦显微镜扫描检查者进行诊断。不熟悉激光共聚焦显微镜诊断的经验不足的检查者的敏感性为 59.5/71.1%，特异性为 94.8/89.8%。经验丰富的检查者的敏感性为 78.5%，特异性为 84.8%。在边缘对照中检测肿瘤残留的结果显示，不熟悉（30.1/33.3%）和有经验的（41.7%）研究人员的检测值不足。本研究中，对实际环境下的基底细胞癌使用激光共聚焦扫描显微镜进行报告，其诊断准确性低于关于人工环境的已发表数据。肿瘤边缘控制的准确性较差具有临床相关性，可能会限制激光共聚焦扫描显微镜在临床常规中的应用。具有苏木精和伊红染色训练知识的病理学家可以部分转移到激光共聚焦扫描显微镜扫描报告中；但是，建议进行专门培训。
