Hartmann D, Stärr L, Maurer M, Stohldreier Y, Buttgereit L, Swarlik A, Sattler E C, French L E, Deußing M
Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany.
Department of Dermatology and Allergy, Munich Municipal Hospital, Munich, Germany.
Exp Dermatol. 2025 Nov;34(11):e70179. doi: 10.1111/exd.70179.
Inflammatory skin diseases are common and often difficult to differentiate. Ex vivo confocal laser scanning microscopy (EVCM) offers a rapid and promising approach. This study aimed to assess the diagnostic utility of EVCM in differentiating inflammatory dermatoses, particularly eczema, psoriasis and lichen planus, by comparing its performance with gold standard histopathology. Tissue samples of 110 patients presenting with inflammatory skin conditions were subjected to both EVCM and conventional histopathology. EVCM images were analysed by three blinded observers, with varying knowledge in histopathology and EVCM, utilising pattern analysis based on Ackermann's classification and single-cell analysis focusing on neutrophil (neutrophils) and eosinophil (eosinophils) granulocytes. Sensitivity and specificity were calculated using contingency tables. We used Cohen's Kappa coefficient and Firth's logistic regression models to evaluate the correlations between disease-associated histopathological features observed via EVCM and histopathology, as well as their impact on accurate histopathological diagnoses. Our findings demonstrate that EVCM provides rapid and insightful visualisation of characteristic features associated with inflammatory dermatological diseases. Diagnostic accuracy varied based on observer experience. The specialist proficient in both EVCM and histopathology achieved the highest accuracy rates for correctly diagnosing lichen planus (97.27%), psoriasis (95.45%) and eczema (92.73%). In conclusion EVCM emerges as a promising adjunct to histopathology, offering a swift and meaningful visualisation of inflammatory disease features. The integration of EVCM could significantly contribute to expediting diagnostic workflows and facilitating prompt, targeted therapeutic interventions. Further research and validation are warranted to establish EVCM's role in routine clinical practice.
炎症性皮肤病很常见，且往往难以鉴别。体外共聚焦激光扫描显微镜（EVCM）提供了一种快速且有前景的方法。本研究旨在通过将其性能与金标准组织病理学进行比较，评估EVCM在鉴别炎症性皮肤病，特别是湿疹、银屑病和扁平苔藓方面的诊断效用。对110例患有炎症性皮肤病的患者的组织样本进行了EVCM检查和传统组织病理学检查。由三名对组织病理学和EVCM了解程度不同的盲法观察者，基于阿克曼分类法利用模式分析以及聚焦于中性粒细胞和嗜酸性粒细胞的单细胞分析，对EVCM图像进行分析。使用列联表计算敏感性和特异性。我们使用科恩卡方系数和菲思逻辑回归模型来评估通过EVCM观察到的与疾病相关的组织病理学特征和组织病理学之间的相关性，以及它们对准确组织病理学诊断的影响。我们的研究结果表明，EVCM能快速且深入地可视化与炎症性皮肤病相关的特征性表现。诊断准确性因观察者经验而异。同时精通EVCM和组织病理学的专家对扁平苔藓（97.27%）、银屑病（95.45%）和湿疹（92.73%）的正确诊断准确率最高。总之，EVCM成为组织病理学的一种有前景的辅助手段，能快速且有意义地可视化炎症性疾病特征。EVCM的整合可显著有助于加快诊断流程，并促进及时、有针对性的治疗干预。有必要进行进一步的研究和验证，以确立EVCM在常规临床实践中的作用。
