Department of Dermatology, Maastricht University Medical Center+, Maastricht, The Netherlands.
GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
J Dermatol. 2024 Jan;51(1):40-47. doi: 10.1111/1346-8138.17020. Epub 2023 Nov 6.
Optical coherence tomography (OCT), a non-invasive diagnostic modality, may replace biopsy for diagnosing basal cell carcinoma (BCC) if a high-confidence BCC diagnosis can be established. In other cases, biopsy remains necessary to establish a histopathological diagnosis and treatment regimen. It is, therefore, essential that OCT assessors have a high specificity for differentiating BCC from non-BCC lesions. To establish high-confidence BCC diagnoses, specific morphological BCC characteristics on OCT are used. This study aimed to review several cases of non-BCC lesions that were misclassified as BCC by experienced OCT assessors, thereby providing insight into the causes of these misclassifications and how they may be prevented. The study population consisted of patients who had a histopathologically-verified non-BCC lesion. Patients from Maastricht University Medical Center+ from February 2021 to April 2021 were included in the study. Two independent OCT assessors assessed OCT scans. One OCT assessor recorded the presence or absence of validated morphological BCC characteristics. A false-positive OCT test result was defined as certainty of BCC presence in a non-BCC lesion. The frequency of misclassifications and the presence or absence of morphological BCC features are discussed. A total of 124 patients with non-BCC lesions were included. Six patients were misclassified by both OCT assessors and are discussed in more detail. Histopathological diagnoses were squamous cell carcinoma (n = 2/21), actinic keratosis (n = 2/29), squamous cell carcinoma in situ/Bowen's disease (n = 1/16), or interphase dermatitis (n = 1/4). In all misclassified cases, multiple, apparent morphological BCC characteristics on OCT were present. Most non-BCC lesions are recognized as such by OCT assessors. However, there remains a small risk that a high-confidence BCC diagnosis is established in non-BCC lesions wherein features mimicking validated BCC characteristics are present. Misclassification may be prevented by careful delineation of epidermal layers and good differentiation between dermal ovoid structures typical of BCC versus squamous cell carcinoma.
光学相干断层扫描（OCT）是一种非侵入性诊断方式，如果能够建立高可信度的基底细胞癌（BCC）诊断，则可能替代活检。在其他情况下，仍需要活检来建立组织病理学诊断和治疗方案。因此，OCT 评估者对于区分 BCC 和非 BCC 病变具有高特异性至关重要。为了建立高可信度的 BCC 诊断，OCT 上使用特定的 BCC 形态学特征。本研究旨在回顾几例被经验丰富的 OCT 评估者误诊为 BCC 的非 BCC 病变，从而深入了解这些误诊的原因以及如何预防这些误诊。研究人群包括经组织病理学证实为非 BCC 病变的患者。该研究纳入了 2021 年 2 月至 2021 年 4 月期间马斯特里赫特大学医学中心+的患者。两名独立的 OCT 评估者评估了 OCT 扫描。一名 OCT 评估者记录了是否存在经过验证的 BCC 形态学特征。假阳性 OCT 检测结果定义为在非 BCC 病变中存在 BCC 的确定性。讨论了误诊的频率以及是否存在 BCC 形态学特征。共纳入 124 例非 BCC 病变患者。两名 OCT 评估者均误诊了 6 例患者，并进行了更详细的讨论。组织病理学诊断为鳞状细胞癌（n=2/21）、光化性角化病（n=2/29）、原位鳞状细胞癌/鲍恩病（n=1/16）或间质性皮炎（n=1/4）。在所有误诊病例中，OCT 上均存在多个明显的 BCC 形态学特征。大多数非 BCC 病变都被 OCT 评估者识别为非 BCC 病变。然而，在存在类似经过验证的 BCC 特征的情况下，仍存在在非 BCC 病变中建立高可信度 BCC 诊断的小风险。通过仔细描绘表皮层并区分典型的 BCC 与鳞状细胞癌的真皮卵圆形结构，可以预防误诊。
