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Ardigò M. Non-invasive techniques in the clinical diagnosis of cutaneous lymphomas. Dermatol Reports 2024; 16:9814. [PMID: 39295885 PMCID: PMC11406206 DOI: 10.4081/dr.2023.9814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/19/2023] [Indexed: 09/21/2024] Open
Abstract
In clinical practice, cutaneous lymphomas can be challenging to diagnose or even suspect because they mimic a variety of other inflammatory and neoplastic dermatological conditions. Support for non-invasive skin analysis methods like reflectance confocal microscopy and dermoscopy is still anecdotic. Practically speaking, a deeper and more comprehensive study with a larger number of cases focusing on the effective usefulness of non-invasive techniques should be taken into consideration because they have demonstrated the ability to identify macro and micro features supporting the clinical suspicion of lymphomas, as well as being useful for differential diagnosis and supporting the selection of the biopsy site. The author provides a brief and narrative synopsis of the reflectance confocal microscopy and dermoscopy characteristics of cutaneous lymphomas in this manuscript.
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Affiliation(s)
- Marco Ardigò
- San Gallicano Dermatological Institute IRCCS, Rome; Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI); Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
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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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Csuka EA, Ward SC, Ekelem C, Csuka DA, Ardigò M, Mesinkovska NA. Reflectance Confocal Microscopy, Optical Coherence Tomography, and Multiphoton Microscopy in Inflammatory Skin Disease Diagnosis. Lasers Surg Med 2021; 53:776-797. [PMID: 33527483 DOI: 10.1002/lsm.23386] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Technological advances in medicine have brought about many novel skin imaging devices. This review aims to evaluate the scientific evidence supporting the use of noninvasive optical imaging techniques to aid in the diagnosis and prognosis of inflammatory skin diseases. STUDY DESIGN/MATERIALS AND METHODS PubMed and Scopus were searched in September 2020 according to PRISMA guidelines for articles using reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and multiphoton microscopy (MPM) in inflammatory skin diseases, excluding studies monitoring treatment efficacy. RESULTS At the time of the study, there were 66 articles that addressed the utilization of noninvasive imaging in interface, spongiotic, psoriasiform, vesiculobullous, and fibrosing/sclerosing inflammatory skin dermatoses: RCM was utilized in 46, OCT in 16, and MPM in 5 articles. RCM was most investigated in psoriasiform dermatoses, whereas OCT and MPM were both most investigated in spongiotic dermatoses, including atopic dermatitis and allergic contact dermatitis. CONCLUSIONS There is preliminary evidence to support the diagnostic potential of noninvasive optical imaging techniques in inflammatory skin diseases. Improvements in the devices and further correlation with histology will help broaden their utility. Additional studies are needed to determine the parameters for diagnostic features, disease differentiation, and staging of inflammatory skin conditions. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Ella A Csuka
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - Suzanne C Ward
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - Chloe Ekelem
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - David A Csuka
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - Marco Ardigò
- San Gallicano Dermatological Institute-IRCCS, Via Chianesi 53, Rome, 00144, Italy
| | - Natasha A Mesinkovska
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
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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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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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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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A Retrospective Study of the Diagnostic Accuracy of In Vivo Reflectance Confocal Microscopy for Basal Cell Carcinoma Diagnosis and Subtyping. J Clin Med 2019; 8:jcm8040449. [PMID: 30987174 PMCID: PMC6518285 DOI: 10.3390/jcm8040449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers.
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Abstract
Cutaneous T-cell lymphomas comprise a heterogeneous group of diseases characterized by monoclonal proliferations of T lymphocytes primarily involving skin, modified skin appendages, and some mucosal sites. This article addresses the basic clinical, histologic, and immunohistochemical characteristics of this group of diseases, with additional attention to evolving literature on dermoscopy, reflectance confocal microscopy, flow cytometry, and molecular data that may increasingly be applied to diagnostic and therapeutic algorithms in these diseases. Select unusual phenotypes or diagnostic examples of classic phenotypes are demonstrated, and flags for consideration while making a pathologic diagnosis of cutaneous T-cell lymphoma are suggested.
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Affiliation(s)
- Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Hoogedoorn L, Peppelman M, van de Kerkhof P, van Erp P, Gerritsen M. The value ofin vivoreflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol 2015; 172:1222-48. [DOI: 10.1111/bjd.13499] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Hoogedoorn
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.E.J. van Erp
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M.J.P. Gerritsen
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
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Moscarella E, Argenziano G, Lallas A, Pellacani G, Longo C. Confocal microscopy: a new era in understanding the pathophysiologic background of inflammatory skin diseases. Exp Dermatol 2014; 23:320-1. [PMID: 24593193 DOI: 10.1111/exd.12364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 12/31/2022]
Abstract
One of the emerging and intriguing applications of reflectance confocal microscopy is the evaluation of 'dynamic' processes of the skin that cannot be otherwise analysed using histopathology that offers a picture of the tissue at one time point. This is nicely illustrated by recent article by Wolberink et al. in the current issue of Exp Dermatol, in which the Authors evaluated patterns and time interval of polymorphonuclear neutrophil (PMN) migration in psoriatic plaques by means of reflectance confocal microscopy (RCM). This example underscores that a new era of confocal microscopy is starting, which promises to reveal a dynamic in vivo understanding of the pathophysiology of human skin diseases.
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Affiliation(s)
- Elvira Moscarella
- Dermatology and Skin Cancer Unit, Arcispedale S.Maria Nuova, IRCCS, Reggio Emilia, Italy
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Agozzino M, Berardesca E, Donadio C, Franceschini C, de Felice CM, Cavallotti C, Sperduti I, Ardigò M. Reflectance Confocal Microscopy Features of Seborrheic Dermatitis for Plaque Psoriasis Differentiation. Dermatology 2014; 229:215-21. [DOI: 10.1159/000363289] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/28/2014] [Indexed: 11/19/2022] Open
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