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首页> 外文会议>Optical biopsy XV: Toward real-time spectroscopic imaging and diagnosis >The bedside diagnostic accuracy of a novice reflectance confocal microscopy reader for skin cancer detection in vivo in real-time: understanding challenges and potential pitfalls
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The bedside diagnostic accuracy of a novice reflectance confocal microscopy reader for skin cancer detection in vivo in real-time: understanding challenges and potential pitfalls

机译：新手反射共聚焦显微镜阅读器在床边的诊断准确性，可在体内实时检测皮肤癌：了解挑战和潜在陷阱

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Reflectance confocal microscopy (RCM) is a non-invasive device that images skin lesions in vivo at a cellular resolution to guide management of patient care. While previous studies have demonstrated high accuracy of RCM in diagnosing skin cancers, most of these studies were performed by experts as a blinded analysis off-site and does not reflect true clinical scenario. We assessed the diagnostic potential of a novice RCM reader, in clinical settings, at the bedside. Over a period of 15 months (August 2015- November 2016), 168 lesions (from 128 cases) were imaged with RCM to determine BCC and or melanoma in dermoscopically equivocal lesions. To evaluate the learning curve of the novice reader, diagnostic accuracy was evaluated at the end of 15 months, as well as during the first half (8 months) and latter half (seven months) of the study. Histopathological diagnosis was available in 95/168 lesions, including 38 melanocytic lesions (ML: 13 melanomas and 25 nevi) and 57 non-melanocytic lesions (NML: 26 BCCs, 4 SCCs and 27 benign). The remaining 73/168 lesions (43.45%) were not biopsied (received topical treatment, monitoring). On RCM, 22/26 (84.61%) BCCs and 11/13 (84.61%) melanomas were correctly diagnosed. BCC was missed in 3/26 (11.53%) lesions and melanoma in 2/13 (15.38%) lesions; these lesions were diagnosed mostly as superficial BCCs and focal epidermal changes overlying deeply situated melanoma nodule on histopathology, respectively. False positive diagnosis of BCC was obtained in 7/23 (30.4%) lesions and of melanoma in 2/22 (4.5%) lesions; these were diagnosed mostly as benign inflamed keratosis and moderately atypical dysplastic nevus on histopathology, respectively. In 7 lesions BCC or melanoma could not be ruled out. A marked increase in the sensitivity and specificity was noticed between the two halves of the study. An overall high diagnostic accuracy of 80.28% with high sensitivity and specificity of 80.68% and 80.8%, respectively in diagnosing skin cancers was obtained. Based on this study, we identified some current limitations and potential pitfalls of RCM. The fact that the diagnostic accuracy of the novice reader increased with time, indicates a learning curve reading RCM images. Additionally, current technical limitations of RCM such as inability to differentiate various cell types, sampling error, and, shallow depth of imaging also lead to false diagnosis. Efforts are ongoing to overcome these challenges by building US based teaching-training program and through a multimodal imaging approach for better diagnosis and patient care.
机译：反射共聚焦显微镜（RCM）是一种非侵入性设备，可以以细胞分辨率在体内对皮肤病变成像，以指导患者护理的管理。尽管先前的研究已经证明RCM在诊断皮肤癌中具有很高的准确性，但是其中大多数研究都是由专家在非现场进行的盲法分析，无法反映真实的临床情况。我们在床边的临床环境中评估了RCM新手阅读器的诊断潜力。在15个月的时间（2015年8月至2016年11月）中，使用RCM对168个病变（来自128例）进行了成像，以确定在皮肤镜下模棱两可的病变中的BCC和/或黑色素瘤。为了评估新手读者的学习曲线，在研究的15个月末以及研究的前半个月（8个月）和后半个月（七个月）评估了诊断准确性。在95/168个病变中可进行组织病理学诊断，包括38个黑素细胞性病变（ML：13个黑色素瘤和25个痣）和57个非黑素细胞性病变（NML：26个BCC，4个SCC和27个良性）。其余的73/168个病灶（43.45％）未进行活检（接受局部治疗，监测）。在RCM上，正确诊断出22/26（84.61％）的BCC和11/13（84.61％）的黑色素瘤。 3/26（11.53％）个病变中漏掉了BCC，2/13（15.38％）个病变中漏掉了黑色素瘤；这些病变主要被诊断为浅表BCC和局灶性表皮变化，分别覆盖组织病理学上深处的黑色素瘤结节。在7/23（30.4％）个病变中获得了BCC的假阳性诊断，在2/22（4.5％）个病变中获得了黑色素瘤；在组织病理学上，这些分别被诊断为良性炎症性角化病和中度非典型增生痣。在7个病变中，不能排除BCC或黑色素瘤。在研究的两半之间发现了敏感性和特异性的显着提高。在诊断皮肤癌中，获得了总体高的诊断准确度（80.28％），高的敏感性和特异性（80.8％）。根据这项研究，我们确定了RCM的一些当前局限性和潜在陷阱。新手阅读器的诊断准确性随时间增加的事实表明读取RCM图像的学习曲线。另外，RCM的当前技术局限性，例如无法区分各种细胞类型，采样误差和浅层成像，也导致了错误的诊断。通过建立基于美国的教学培训计划并通过多模式成像方法来更好地诊断和护理病人，正在努力克服这些挑战。

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