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Taleb E, Yélamos O, Ardigo M, Christensen RE, Geller S. Non-invasive Skin Imaging in Cutaneous Lymphomas. Am J Clin Dermatol 2024; 25:79-89. [PMID: 37964050 PMCID: PMC10842086 DOI: 10.1007/s40257-023-00824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
The diagnosis of cutaneous lymphomas is challenging and requires skin tissue for histology and immunophenotyping using immunohistochemistry and molecular studies. In recent years, the role of non-invasive imaging techniques has been described as part of the clinical assessment of cutaneous lymphoma lesions. Imaging modalities such as dermoscopy, reflectance confocal microscopy (RCM), and high frequency ultrasound (HFUS) have been shown to be very valuable in raising the clinical suspicion for lymphomas of the skin, and in distinguishing cutaneous lymphomas from inflammatory dermatoses such as lupus, psoriasis, or eczema. These non-invasive methods can be used to direct the clinician to the optimal biopsy site to maximize the histopathological results and minimize false negatives. These methods also have a potential place in monitoring treatment response. In this review we present a concise summary of the dermoscopic imaging, RCM, and HFUS features seen in cutaneous T-cell lymphomas (CTCL) and B-cell lymphomas (CBCL).
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Affiliation(s)
- Eyal Taleb
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriol Yélamos
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB, SANT PAU), Barcelona, Spain
| | - Marco Ardigo
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Rachel E Christensen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY, 10021, USA
| | - Shamir Geller
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY, 10021, USA.
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Melhoranse Gouveia B, Wells J, Kim J, Collgros H, Guitera P, Longo C, Fernandez-Penas P. Reflectance confocal microscopy role in mycosis fungoides follow-up. Skin Res Technol 2020; 27:414-421. [PMID: 33098224 DOI: 10.1111/srt.12967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is a useful tool for many skin cancers, allowing non-invasive evaluation over time and identifying areas of active disease. Its role to follow-up mycosis fungoides (MF) patients has not yet been evaluated. OBJECTIVE To assess the level of agreement between RCM and histopathology and to develop a RCM checklist that could help monitoring MF patients. METHOD Prospective study in a cutaneous lymphoma clinic of a tertiary hospital in Australia. RCM and biopsies were performed on the same area at baseline, before commencing or changing treatment, and at 6 months after starting treatment. Normal skin sites were also analysed and acted as controls. RCM features and histopathological findings were blindly evaluated by the confocalist and pathologist. Correlation between RCM and histology was measured by overall per cent of agreement (OPA), kappa and ROC curves. Additionally, RCM images before and after treatment were assessed blinded from clinical information and correlated to clinical assessment. RESULTS Thirty-eight MF lesions were included. Nineteen of these 38 were re-assessed by RCM 6 months later. Fifty biopsies were performed (38 at baseline and 12 after 6 months). The combination of four RCM features corresponding to Pautrier's microabscess, epidermal and junctional lymphocytes and interface dermatitis formed the RCM checklist for MF that predicted the severity of disease with AUC of 0.95 (P = .003). CONCLUSION Reflectance confocal microscopy can assess activity within a lesion and over time and assist in the clinical management of patients with MF.
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Affiliation(s)
- Bruna Melhoranse Gouveia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Jillian Wells
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia
| | - Jennifer Kim
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW, Australia
| | - Helena Collgros
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Pascale Guitera
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Italy
| | - Pablo Fernandez-Penas
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia
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Kurzeja M, Czuwara J, Walecka I, Olszewska M, Rudnicka L. Features of classic lichen planopilaris and frontal fibrosing alopecia in reflectance confocal microscopy: A preliminary study. Skin Res Technol 2020; 27:266-271. [PMID: 32743819 DOI: 10.1111/srt.12940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Classic lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary lymphocytic cicatricial alopecia. In patients with ambiguous clinical presentation, reflectance confocal microscopy (RCM) a new noninvasive skin imaging technique, could be a helpful diagnostic tool. The aim of our study was to describe the characteristic features of classic LPP and FFA using RCM. MATERIALS AND METHODS Ten patients with classic lichen planopilaris and two with frontal fibrosing alopecia were examined with RCM. RESULTS Lichenoid inflammatory infiltrate around the hair follicle was observed in three cases of classic LPP and FFA (3/12; 25.0%). Extensive perifollicular fibrosis was seen in nine patients (9/12; 75.0%) with classic LPP and FFA. An increased number of white, ill-defined, coarse dermal fibers at the level of the superficial dermis were visible in seven cases (7/12; 58.3%). Moreover, dilated blood vessels were present in seven patients with classic LPP and FFA (7/12; 58.3%). CONCLUSION Summing up, reflectance confocal microscopy allows to visualize major key diagnostic features of classic lichen planopilaris and frontal fibrosing alopecia in the real time. The value of RCM examination in scarring alopecia needs to be further evaluated, but it appears to be a useful adjuvant tool for the initial diagnosis of classic LPP and FFA.
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Affiliation(s)
- Marta Kurzeja
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology Centre of Postgraduate Medical Education/CSK MSWIA, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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4
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Franceschini C, Persechino F, Ardigò M. In Vivo Reflectance Confocal Microscopy in General Dermatology: How to Choose the Right Indication. Dermatol Pract Concept 2020; 10:e2020032. [PMID: 32363095 DOI: 10.5826/dpc.1002a32] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/31/2022] Open
Abstract
Reflectance confocal microscopy (RCM) is a high-resolution, noninvasive imaging technique being increasingly used as an aid to diagnosis in the dermatology setting. RCM is applied in the diagnosis of both melanoma and nonmelanoma skin tumors, but also in the interpretation and management of inflammatory skin diseases. Two different devices with different designs for specific indications are available in the market: a static and a handheld probe. Several clinical presentations of the lesion could affect the examination, such as the presence of ulceration or hyperkeratosis; moreover, the anatomical site can drive the probe selection as well as the effective indication to RCM examination. In this review article, indications for the use of RCM are described in detail with a schematic approach for practical purposes.
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Affiliation(s)
- Chiara Franceschini
- Clinical Dermatology Department, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
| | - Flavia Persechino
- Clinical Dermatology Department, San Gallicano Dermatological Institute (IRCCS), Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Marco Ardigò
- Clinical Dermatology Department, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
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Melo DF, De Carvalho N, Ardigò M, Pellacani G, Mota ANCDM, Barreto TDM, Jorge Machado C, Pineiro‐Maceira JM, Barcaui CB. Concordance among in vivo reflectance confocal microscopy, trichoscopy, and histopathology in the evaluation of scalp discoid lupus. Skin Res Technol 2020; 26:675-682. [DOI: 10.1111/srt.12852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/02/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Daniel Fernandes Melo
- Dermatology Department University of State of Rio de Janeiro (UERJ) Rio de Janeiro Brazil
- Dermatology Department Marcílio Dias Naval Hospital Rio de Janeiro Brazil
| | | | - Marco Ardigò
- Clinical Dermatology San Galicano Dermatology Institute‐IRCCS Rome Italy
| | - Giovanni Pellacani
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - Amanda Nascimento Cavalleiro de Mac Mota
- Dermatology Department University of State of Rio de Janeiro (UERJ) Rio de Janeiro Brazil
- Dermatology Department Central Aeronautics Hospital Rio de Janeiro Brazil
| | | | - Carla Jorge Machado
- Preventive and Social Medicine Department Federal University of Minas Gerais Belo Horizonte Brazil
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Melhoranse Gouveia B, Wells J, Kim J, Consuegra G, Longo C, Fernandez-Penas P. Systematic review and proposal of an in vivo reflectance confocal microscopy assessment tool for cutaneous lymphoma. J Cutan Pathol 2019; 47:295-304. [PMID: 31618473 DOI: 10.1111/cup.13598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is a non-invasive imaging technique that provides dynamic information and allows in vivo monitoring, with excellent histologic correlation. In the last decade, the use of RCM for cutaneous T-cell lymphomas (CTCL) has been reported. CTCL may require multiple biopsies for diagnosis due to its equivocal clinical presentation. RCM was described as a possible tool to help determine the best site for skin biopsy. This study aims to systematically review all RCM features reported in literature for CTCL. METHOD A systematic literature search concerning CTCL evaluated by RCM was performed in eight electronic databases until May 2019 following PRISMA-DTA quality assessment. RESULTS Eighteen RCM features were described in patients with CTCL. The most frequent were: interface dermatitis (89%), epidermal lymphocytes (82%), epidermal architectural disarray (81%), and vesicle-like structure (Pautrier microabscess) (51%). CONCLUSION In order to establish comparable parameters among the studies identified, we proposed descriptors for CTCL features and a grading system to quantify them. This will facilitate to define the role of RCM in the diagnosis and monitoring of CTCL patients.
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Affiliation(s)
| | - Jillian Wells
- Department of Dermatology, Westmead Hospital, Sydney, Australia
| | - Jennifer Kim
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
| | | | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
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7
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Franceschini C, Garelli V, Persechino F, Sperduti I, Caro G, Rossi A, Ardigò M. Dermoscopy and confocal microscopy for different chemotherapy‐induced alopecia (CIA) phases characterization: Preliminary study. Skin Res Technol 2019; 26:269-276. [DOI: 10.1111/srt.12790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Chiara Franceschini
- Clinical Dermatology Department San Gallicano Dermatological Institute‐IRCCS Rome Italy
| | - Valentina Garelli
- Department of Plastic and Reconstructive Surgery San Gallicano Dermatological Institute‐IRCCS Rome Italy
| | - Flavia Persechino
- Clinical Dermatology Department San Gallicano Dermatological Institute‐IRCCS Rome Italy
- Department of Clinical and Molecular Medicine “Sapienza” University of Rome Rome Italy
| | - Isabella Sperduti
- Biostatistical Unit Scientific Direction San Gallicano Dermatological Institute‐IRCCS Rome Italy
| | - Gemma Caro
- Department of Internal Medicine and Medical Specialties “Sapienza” University of Rome Rome Italy
| | - Alfredo Rossi
- Department of Internal Medicine and Medical Specialties “Sapienza” University of Rome Rome Italy
| | - Marco Ardigò
- Clinical Dermatology Department San Gallicano Dermatological Institute‐IRCCS Rome Italy
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8
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Ilie MA, Caruntu C, Lupu M, Lixandru D, Tampa M, Georgescu SR, Bastian A, Constantin C, Neagu M, Zurac SA, Boda D. Current and future applications of confocal laser scanning microscopy imaging in skin oncology. Oncol Lett 2019; 17:4102-4111. [PMID: 30944603 PMCID: PMC6444326 DOI: 10.3892/ol.2019.10066] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/10/2018] [Indexed: 11/05/2022] Open
Abstract
Confocal laser scanning microscopy (CLSM) is a modern imaging technique that enables the in vivo or ex vivo characterization of skin lesions located in the epidermis and superficial dermis with a high quasi-microscopic resolution. Currently, it is considered to be the most promising imaging tool for the evaluation of superficial skin tumors. The in vivo mode adds the advantage of noninvasive, dynamic, in real-time assessment of the tumor associated vasculature and inflammation. It offers the possibility to repeatedly examine the same skin area without causing any damage and to monitor disease progression and treatment outcome. Furthermore, this novel technology allows the evaluation of the entire lesion and can be used to guide biopsies and to define tumor margins before surgical excision or other invasive therapies. CLSM diagnostic features may differentiate between the various histologic subtypes of skin tumors and therefore helps in choosing the best therapeutic approach. In this study, we present the CLSM characteristic features of the most common melanocytic and non-melanocytic skin tumors, as well as future possible CLSM applications in the study of experimental skin tumorigenesis on animal models.
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Affiliation(s)
- Mihaela Adriana Ilie
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Biochemistry, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Mihai Lupu
- Department of Dermatology, MEDAS Medical Center, 030442 Bucharest, Romania
| | - Daniela Lixandru
- Department of Biochemistry, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mircea Tampa
- Department of Dermatology, ‘Victor Babes’ Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 030303 Bucharest, Romania
| | - Simona-Roxana Georgescu
- Department of Dermatology, ‘Victor Babes’ Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 030303 Bucharest, Romania
| | - Alexandra Bastian
- Department of Pathology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Carolina Constantin
- Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Department of Immunology, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | - Monica Neagu
- Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Department of Immunology, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
- Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
| | - Sabina Andrada Zurac
- Department of Pathology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Prof. N. Paulescu’ National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
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Fabbrocini G, Mazzella C, Cantelli M, Baldo A, Russo D, De Rosa G, Monfrecola G. Reflectance Confocal Microscopy as New Diagnostic Tool in Folliculotropic Mycosis Fungoides. Skin Appendage Disord 2017; 4:118-121. [PMID: 29765972 DOI: 10.1159/000479822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/26/2017] [Indexed: 12/19/2022] Open
Abstract
We present a case of folliculotropic mycosis fungoides (FMF), a variant of cutaneous T-cell lymphoma which particularly affects hair follicles. FMF can imitate a wide variety of otherwise benign dermatoses, so it poses major diagnostic obstacles both for the dermatologist as well as the dermatopathologist. In our case, in vivo reflectance confocal microscopy (RCM) was very important for guiding the skin biopsy site selection. For this reason, RCM can reduce the number of unsuccessful histopathological examinations and increase the diagnostic accuracy for different skin dermatoses.
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Affiliation(s)
- Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Caterina Mazzella
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Mariateresa Cantelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Antonello Baldo
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Daniela Russo
- Pathology Section, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Gaetano De Rosa
- Pathology Section, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giuseppe Monfrecola
- Dermatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Agozzino M, Gonzalez S, Ardigò M. Reflectance Confocal Microscopy for Inflammatory Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Reflectance Confocal Microscopy for Inflammatory Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:631-9. [DOI: 10.1016/j.ad.2016.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/10/2016] [Accepted: 01/28/2016] [Indexed: 11/23/2022] Open
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Ardigo M, Agozzino M, Franceschini C, Lacarrubba F. Reflectance Confocal Microscopy Algorithms for Inflammatory and Hair Diseases. Dermatol Clin 2016; 34:487-496. [DOI: 10.1016/j.det.2016.05.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Ardigò M, Agozzino M, Franceschini C, Donadio C, Abraham LS, Barbieri L, Sperduti I, Berardesca E, González S. Reflectance confocal microscopy for scarring and non-scarring alopecia real-time assessment. Arch Dermatol Res 2016; 308:309-18. [DOI: 10.1007/s00403-016-1657-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/21/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Mancebo SE, Cordova M, Myskowski PL, Flores ES, Busam K, Jawed SI, Skripnik A, Rajadhyaksha M, Querfeld C. Reflectance confocal microscopy features of mycosis fungoides and Sézary syndrome: correlation with histopathologic and T-cell receptor rearrangement studies. J Cutan Pathol 2016; 43:505-15. [PMID: 26969149 DOI: 10.1111/cup.12708] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Mycosis fungoides/Sézary syndrome (MF/SS) often requires multiple skin biopsies for definitive diagnosis. In vivo reflectance confocal microscopy (RCM) visualizes high-resolution cellular detail of the skin. The objective of this study is to evaluate the morphologic features of MF/SS using RCM and to correlate RCM features with histopathology and T-cell receptor (TCR) gene rearrangement studies. METHODS A cohort of patients with active/recurrent or suspicious MF/SS disease was prospectively recruited for RCM imaging and histopathologic/RCM images were evaluated. Statistical analyses were performed to identify unique RCM features and to correlate RCM features with histopathologic findings and TCR rearrangement studies. RESULTS Eighty-three lesions were evaluated. Correlation between RCM and histopathology was moderate for all relatable features (κ = 0.41, p<0.001), almost perfect for intraepidermal atypical lymphocytes [prevalence and bias-adjusted kappa (PABAK) = 0.90], and fair for Pautrier collections (κ = 0.32, p = 0.03). Lesions with Pautrier collections identified by RCM were significantly more likely to show TCR clonality (p = 0.04) and diagnostic features of MF/SS on histopathology (p = 0.03). CONCLUSIONS Our study captures morphologic RCM criteria for a variety of skin lesions. Pautrier collections visualized by RCM are associated with improved histopathologic diagnosis and detection of TCR gene clonality. Although further studies are needed to validate the diagnostic implications of RCM for MF/SS, our study highlights the potential utility of RCM.
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Affiliation(s)
- Silvia E Mancebo
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel Cordova
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia L Myskowski
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Eileen S Flores
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah I Jawed
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Anna Skripnik
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Milind Rajadhyaksha
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christiane Querfeld
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology and Dermatology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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