Sollena Pietro, Salvi Marisa, Marraffa Marica, Pellegrino Luca, Cappilli Simone, Palmisano Gerardo, Mannino Maria, Di Nardo Lucia, Di Stefani Alessandro, Peris Ketty
UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy.
Int J Dermatol. 2025 Apr;64(4):719-724. doi: 10.1111/ijd.17520. Epub 2024 Nov 3.
Targeted and immune therapies have recently been associated with the occurrence of multiple cutaneous toxicities, often challenging to differentiate by clinical examination alone without histology. Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive and innovative imaging technique that has been shown to be almost as effective as histology in diagnosing several skin conditions. Our study aimed to assess the effectiveness of LC-OCT in predicting the clinical evolution of early maculopapular eruptions related to antineoplastic targeted therapy and immunotherapy.
In the period between May 2023 and December 2023, consecutive patients with clinical cutaneous maculopapular reactions caused by oncologic targeted therapy or immunotherapy were enrolled at the dermatologic outpatient clinic of the Fondazione Policlinico A. Gemelli IRCCS, Rome. Patients underwent clinical dermatological examination, video-dermoscopy, LC-OCT, and incisional skin biopsy of a target cutaneous lesion. To investigate the evolutionary pattern of maculopapular lesions (psoriasic eruption, lichenoid eruption, eczematous eruption, bullous eruption), LC-OCT and histopathological images have been compared based on specific characteristics (hyperkeratosis, acanthosis, spongiosis; papillomatosis; lichenoid inflammatory infiltrate; presence of intraepidermal/subepidermal cleavage plan with formation of a bulla).
Eighteen patients were included in this study (11 males, 7 females, median age 64.5). LC-OCT demonstrated an overall concordance with histology of 77.8%, with a Cohen's Kappa of 0.69 (P < 0.0001). Sensitivity exceeded 70%, and specificity was ≥88.2%. The Area Under the Curve (AUC) ranged from 0.9 to 1 for psoriasis and lichenoid eruption and from 0.7 to 0.9 for eczematous and bullous eruption.
LC-OCT appears to be a promising tool for the early differential diagnosis of adverse skin reactions related to targeted therapy and immunotherapy, offering the potential to avoid skin biopsies in fragile cancer patients.
靶向治疗和免疫治疗最近与多种皮肤毒性的发生相关，仅通过临床检查而不进行组织学检查往往难以区分。线场共聚焦光学相干断层扫描（LC-OCT）是一种非侵入性的创新成像技术，已被证明在诊断多种皮肤病方面几乎与组织学一样有效。我们的研究旨在评估LC-OCT在预测与抗肿瘤靶向治疗和免疫治疗相关的早期斑丘疹皮疹临床演变方面的有效性。
在2023年5月至2023年12月期间，罗马圣心天主教大学综合医院皮肤病门诊连续纳入了因肿瘤靶向治疗或免疫治疗引起临床皮肤斑丘疹反应的患者。患者接受了临床皮肤科检查、视频皮肤镜检查、LC-OCT检查以及对目标皮肤病变进行切开皮肤活检。为了研究斑丘疹病变（银屑病样皮疹、苔藓样皮疹、湿疹样皮疹、大疱性皮疹）的演变模式，基于特定特征（角化过度、棘层肥厚、海绵形成；乳头瘤样增生；苔藓样炎性浸润；表皮内/表皮下裂隙平面形成水疱）对LC-OCT和组织病理学图像进行了比较。
本研究共纳入18例患者（11例男性，7例女性，中位年龄64.5岁）。LC-OCT与组织学的总体一致性为77.8%，Cohen's Kappa系数为0.69（P < 0.0001）。敏感性超过70%，特异性≥88.2%。银屑病和苔藓样皮疹的曲线下面积（AUC）范围为0.9至1，湿疹样和大疱性皮疹的AUC范围为0.7至0.9。
LC-OCT似乎是一种有前景的工具，可用于早期鉴别与靶向治疗和免疫治疗相关的皮肤不良反应，有可能避免对体弱癌症患者进行皮肤活检。
