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Razi S, Kuo YH, Pathak G, Agarwal P, Horgan A, Parikh P, Deshmukh F, Rao BK. Line-Field Confocal Optical Coherence Tomography for the Diagnosis of Skin Tumors: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:1522. [PMID: 39061659 DOI: 10.3390/diagnostics14141522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
A line-field confocal optical coherence tomography (LC-OCT) combines confocal microscopy and optical coherence tomography into a single, rapid, easy-to-use device. This meta-analysis was performed to determine the reliability of LC-OCT for diagnosing malignant skin tumors. PubMed, EMBASE, Web of Science databases, and the Cochrane Library were searched for research studies in the English language from inception till December 2023. To assess quality and the risk of bias, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used. The sensitivity and specificity of each study were calculated. The bivariate summary sensitivity and specificity were calculated using the linear mixed model. Five studies with 904 reported per lesion analyses in our study; the specificity and sensitivity ranged from 67% to 97% and 72% to 92%, respectively. The pooled specificity and sensitivity were 91% (95% CI: 76-97%) and 86.9% (95% CI: 81.8-90.8%), respectively. The summary sensitivity and specificity from the bivariate approach are 86.9% (95% CI: 81.8-90.8%) and 91.1% (95% CI: 76.7-97.0%), respectively. The area under the curve is 0.914. LC-OCT shows great sensitivity and specificity in diagnosing malignant skin tumors. However, due to the limited number of studies included in our meta-analysis, it is premature to elucidate the true potential of LC-OCT.
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Affiliation(s)
- Shazli Razi
- Department of Internal Medicine, Hackensack Meridian Ocean University Medical Center, Brick, NJ 08724, USA
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Yen-Hong Kuo
- Office of Research Administration, Hackensack Meridian Health Research Institute, Nutley, NJ 07110, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Gaurav Pathak
- Center for Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| | - Priya Agarwal
- Center for Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| | - Arianna Horgan
- Center for Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| | - Prachi Parikh
- Center for Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| | - Farah Deshmukh
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Babar K Rao
- Center for Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Dermatology, Rao Dermatology, Atlantic Highlands, NJ 07716, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
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Verzì AE, Broggi G, Caltabiano R, Micali G, Lacarrubba F. Line-field confocal optical coherence tomography of lentigo maligna with horizontal and vertical histopathologic correlations. J Cutan Pathol 2023; 50:118-122. [PMID: 36056910 PMCID: PMC10087826 DOI: 10.1111/cup.14321] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/26/2022] [Accepted: 08/28/2022] [Indexed: 01/24/2023]
Abstract
Lentigo maligna (LM) is a subtype of in situ melanoma that classically presents in elderly patients as a slowly growing lesion on sun-exposed areas that may evolve to invasive melanoma. Line-field confocal optical coherence tomography (LC-OCT) is a new non-invasive technique for a real-time, vertical, and horizontal skin imaging with high resolution close to conventional histopathology. We present the LC-OCT features of an LM of the nose in a 49-year-old white man along with their horizontal and vertical histopathological correlations. LC-OCT was able to detect in vivo, in both horizontal and vertical imaging, the main microscopic features typical of LM by showing, in the epidermis and around the hair follicles, the presence of large, bright roundish, or dendritic atypical cells, with evident nuclei, corresponding to atypical melanocytes with a tendency toward folliculotropism. A strong correspondence between LC-OCT images and vertical and horizontal histopathological sections was observed. Our study, although limited to a single case, is indicative of the great potential of LC-OCT to improve the non-invasive diagnosis of LM.
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Affiliation(s)
| | - Giuseppe Broggi
- Department "G.F. Ingrassia," Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department "G.F. Ingrassia," Section of Anatomic Pathology, University of Catania, Catania, Italy
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Lacarrubba F, Micali G, Trecarichi AC, Quattrocchi E, Monfrecola G, Verzì AE. New Developing Treatments for Molluscum Contagiosum. Dermatol Ther (Heidelb) 2022; 12:2669-2678. [PMID: 36239905 PMCID: PMC9674806 DOI: 10.1007/s13555-022-00826-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
A large variety of treatments for molluscum contagiosum (MC) are available, but none are Food and Drug Administration (FDA) approved and there is no consensus on the optimal approach, mainly owing to a lack of high-level data. Physical modalities are widely used, but require repeated outpatient visits for administration, are painful and difficult to perform in children, and are associated with the possibility of residual scarring and post-inflammatory hypo- or hyperpigmentation. Two experimental topical drugs, a new standardized preparation of topical cantharidin, called VP-102, and a topical nitric oxide (NO)-releasing product containing berdazimer, called SB206, represent promising products that have been designed to overcome the limitations of current treatments. They have recently shown good results in terms of safety and efficacy in large cohorts of patients in phase III studies and have the potential to be the first FDA-approved therapies for the treatment of MC.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | | | | | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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Verzì AE, Broggi G, Micali G, Sorci F, Caltabiano R, Lacarrubba F. Line-field confocal optical coherence tomography of psoriasis, eczema and lichen planus: a case series with histopathological correlation. J Eur Acad Dermatol Venereol 2022; 36:1884-1889. [PMID: 35666617 PMCID: PMC9540560 DOI: 10.1111/jdv.18293] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Line-field confocal optical coherence tomography (LC-OCT) is a novel, non-invasive technique that provides in vivo, high-resolution images in both vertical and horizontal sections. OBJECTIVES The aim of the study was to evaluate LC-OCT imaging in some inflammatory disorders and to correlate the resulting features with histopathology. METHODS The retrospective study included patients with histopathological confirmed diagnosis of plaque psoriasis, atopic eczema and lichen planus, who were imaged with LC-OCT before the biopsy. LC-OCT was performed with the commercially available LC-OCT device. RESULTS A total of 15 adult patients with histopathologically proven plaque psoriasis (N: 5), atopic eczema (N: 5) and lichen planus (N: 5) were included. In all cases, LC-OCT allowed the in vivo recognition of the main microscopic features of the examined inflammatory skin disease, with a strong correlation with histopathology. CONCLUSIONS Although future studies on larger series of patients are necessary, LC-OCT, based on these preliminary findings, may represent a promising tool in inflammatory skin disorders with potential applications including enhanced diagnosis, biopsy guidance, follow-up and treatment monitoring.
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Affiliation(s)
- A E Verzì
- Dermatology Clinic, University of Catania, Catania, Italy
| | - G Broggi
- Dermatology Clinic, University of Catania, Catania, Italy.,Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Sorci
- Dermatology Clinic, University of Catania, Catania, Italy
| | - R Caltabiano
- Dermatology Clinic, University of Catania, Catania, Italy.,Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
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Gust C, Schuh S, Welzel J, Daxenberger F, Hartmann D, French LE, Ruini C, Sattler EC. Line-Field Confocal Optical Coherence Tomography Increases the Diagnostic Accuracy and Confidence for Basal Cell Carcinoma in Equivocal Lesions: A Prospective Study. Cancers (Basel) 2022; 14:cancers14041082. [PMID: 35205830 PMCID: PMC8870684 DOI: 10.3390/cancers14041082] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Basal cell carcinoma is the most frequently occurring type of skin cancer. Its treatment can be either local or surgical depending on its subtype and extension, with early recognized and superficial cases being easier to treat. Some of them, however, display unspecific features, making diagnosis difficult. Non-invasive devices such as line-field confocal optical coherence tomography (LC-OCT) are able to recognize morphological features of different BCC subtypes with a good correlation to histopathology. We decided to study their application to clinically doubtful BCC cases. Abstract Diagnosing clinically unclear basal cell carcinomas (BCCs) can be challenging. Line-field confocal optical coherence tomography (LC-OCT) is able to display morphological features of BCC subtypes with good histological correlation. The aim of this study was to investigate the accuracy of LC-OCT in diagnosing clinically unsure cases of BCC compared to dermoscopy alone and in distinguishing between superficial BCCs and other BCC subtypes. Moreover, we addressed pitfalls in false positive cases. We prospectively enrolled 182 lesions of 154 patients, referred to our department to confirm or to rule out the diagnosis of BCC. Dermoscopy and LC-OCT images were evaluated by two experts independently. Image quality, LC-OCT patterns and criteria, diagnosis, BCC subtype, and diagnostic confidence were assessed. Sensitivity and specificity of additional LC-OCT were compared to dermoscopy alone for identifying BCC in clinically unclear lesions. In addition, key LC-OCT features to distinguish between BCCs and non-BCCs and to differentiate superficial BCCs from other BCC subtypes were determined by linear regressions. Diagnostic confidence was rated as “high” in only 48% of the lesions with dermoscopy alone compared to 70% with LC-OCT. LC-OCT showed a high sensitivity (98%) and specificity (80%) compared to histology, and these were even higher (100% sensitivity and 97% specificity) in the subgroup of lesions with high diagnostic confidence. Interobserver agreement was nearly perfect (95%). The combination of dermoscopy and LC-OCT reached a sensitivity of 100% and specificity of 81.2% in all cases and increased to sensitivity of 100% and specificity of 94.9% in cases with a high diagnostic confidence. The performance of LC-OCT was influenced by the image quality but not by the anatomical location of the lesion. The most specific morphological LC-OCT criteria in BCCs compared to non-BCCs were: less defined dermoepidermal junction (DEJ), hyporeflective tumor lobules, and dark rim. The most relevant features of the subgroup of superficial BCCs (sBCCs) were: string of pearls pattern and absence of epidermal thinning. Our diagnostic confidence, sensitivity, and specificity in detecting BCCs in the context of clinically equivocal lesions significantly improved using LC-OCT in comparison to dermoscopy only. Operator training for image acquisition is fundamental to achieve the best results. Not only the differential diagnosis of BCC, but also BCC subtyping can be performed at bedside with LC-OCT.
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Affiliation(s)
- Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86179 Augsburg, Germany; (S.S.); (J.W.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, 86179 Augsburg, Germany; (S.S.); (J.W.)
| | - Fabia Daxenberger
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
| | - Lars E. French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: (C.R.); (E.C.S.); Tel.: +49-(0)89-4400-56010 (C.R.)
| | - Elke C. Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
- Correspondence: (C.R.); (E.C.S.); Tel.: +49-(0)89-4400-56010 (C.R.)
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