Mtimet Lyna, Boussingault Lucas, Aktas Dina, Fontaine Margot, Orte Cano Carmen, Diet Gwendoline, Lenoir Clement, Miyamoto Makiko, Cinotti Elisa, Tognetti Linda, Cartocci Alessandra, Rubegni Pietro, Puig Susana, Malvehy Josep, Perez-Anker Javiera, Perrot Jean-Luc, Del Marmol Véronique, Suppa Mariano
Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, Brussels, Belgium.
Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
J Eur Acad Dermatol Venereol. 2024 Dec 2. doi: 10.1111/jdv.20459.
Line-field confocal optical coherence tomography (LC-OCT) represents one of the newest non-invasive in vivo skin imaging techniques. Previous studies described morphologic criteria of basal cell carcinoma (BCC) under LC-OCT examination. Preliminary data on LC-OCT diagnostic performance for BCC have recently been published but showed only a modest improvement compared to dermoscopy, possibly due to study limitations.
The main objective of this study was to find diagnostic performance parameters of LC-OCT for differentiating BCC from its clinical/dermoscopic mimickers and for discriminating among BCC subtypes. An additional objective was to suggest a simple, user-friendly diagnostic algorithm based on the most powerful LC-OCT features in the field of BCC and its imitators.
Equivocal BCC lesions imaged with an LC-OCT device prior to biopsy/excision were included. Three observers blinded for histopathological diagnosis retrospectively formulated clinical, dermoscopic and LC-OCT diagnoses and evaluated LC-OCT features for each study lesion.
A total of 303 lesions (173 BCCs and 130 non-BCCs) from 225 patients were included. For the differentiation of BCC from BCC imitators, the use of LC-OCT increased the diagnostic accuracy compared to clinical examination by 24% and compared to dermoscopy by 12%. For the discrimination of sBCC from other BCC subtypes, LC-OCT increased the diagnostic accuracy compared to clinical examination by 18% and compared to dermoscopy by 12%. The presence of lobule with millefeuille pattern was a significant feature for BCC diagnosis. Lobule shape and location allowed BCC subtype discrimination.
The accuracy of BCC diagnosis can be increased by at least 12% with the use of LC-OCT compared to clinical and dermoscopic examinations alone, both in terms of BCC differentiation from clinical/dermoscopic imitators and in terms of BCC-subtype discrimination. A diagnostic algorithm based on significant features for BCC diagnosis is proposed, for which further validation is required.
线场共焦光学相干断层扫描（LC-OCT）是最新的非侵入性体内皮肤成像技术之一。先前的研究描述了LC-OCT检查下基底细胞癌（BCC）的形态学标准。最近公布了关于LC-OCT对BCC诊断性能的初步数据，但与皮肤镜检查相比仅显示出适度的改善，这可能是由于研究局限性所致。
本研究的主要目的是找到LC-OCT用于区分BCC与其临床/皮肤镜模仿病变以及区分BCC亚型的诊断性能参数。另一个目的是基于BCC及其模仿病变领域中最强大的LC-OCT特征，提出一种简单、用户友好的诊断算法。
纳入在活检/切除前用LC-OCT设备成像的可疑BCC病变。三名对组织病理学诊断不知情的观察者回顾性地制定临床、皮肤镜和LC-OCT诊断，并评估每个研究病变的LC-OCT特征。
共纳入225例患者的303个病变（173个BCC和130个非BCC）。对于区分BCC与BCC模仿病变，与临床检查相比，使用LC-OCT可将诊断准确性提高24%，与皮肤镜检查相比提高12%。对于区分浅表型BCC（sBCC）与其他BCC亚型，与临床检查相比，LC-OCT可将诊断准确性提高18%，与皮肤镜检查相比提高12%。具有千层饼样模式的小叶的存在是BCC诊断的一个重要特征。小叶形状和位置有助于BCC亚型的区分。
与单独的临床和皮肤镜检查相比，使用LC-OCT在区分BCC与临床/皮肤镜模仿病变以及BCC亚型区分方面，BCC诊断的准确性可提高至少12%。提出了一种基于BCC诊断重要特征的诊断算法，需要进一步验证。
