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In vivo assessment of optical properties of melanocytic skin lesions and differentiation of melanoma from non-malignant lesions by high-definition optical coherence tomography

机译：高清晰度光学相干断层扫描技术在体内评估黑素细胞性皮肤病变的光学特性以及黑色素瘤与非恶性病变的区别

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One of the most challenging problems in clinical dermatology is the early detection of melanoma. Reflectance confocal microscopy (RCM) is an added tool to dermoscopy improving considerably diagnostic accuracy. However, diagnosis strongly depends on the experience of physicians. High-definition optical coherence tomography (HD-OCT) appears to offer additional structural and cellular information on melanocytic lesions complementary to that of RCM. However, the diagnostic potential of HD-OCT seems to be not high enough for ruling out the diagnosis of melanoma if based on morphology analysis. The aim of this paper is first to quantify in vivo optical properties such as light attenuation in melanocytic lesions by HD-OCT. The second objective is to determine the best critical value of these optical properties for melanoma diagnosis. The technique of semi-log plot whereby an exponential function becomes a straight line has been implemented on HD-OCT signals coming from four successive skin layers (epidermis, upper papillary dermis, deeper papillary dermis and superficial reticular dermis). This permitted the HD-OCT in vivo measurement of skin entrance signal (SES), relative attenuation factor normalized for the skin entrance signal (µraf1) and half value layer (z1/2). The diagnostic accuracy of HD-OCT for melanoma detection based on the optical properties, µraf1, SES and z1/2 was high (95.6, 82.2 and 88.9 %, respectively). High negative predictive values could be found for these optical properties (96.7, 89.3 and 96.3 %, respectively) compared to morphologic assessment alone (89.9 %), reducing the risk of mistreating a malignant lesion to a more acceptable level (3.3 % instead of 11.1 %). HD-OCT seems to enable the combination of in vivo morphological analysis of cellular and 3-D micro-architectural structures with in vivo analysis of optical properties of tissue scatterers in melanocytic lesions. In vivo HD-OCT analysis of optical properties permits melanoma diagnosis with higher accuracy than in vivo HD-OCT analysis of morphology alone.
机译：临床皮肤病学中最具挑战性的问题之一是黑色素瘤的早期发现。反射共聚焦显微镜（RCM）是皮肤镜检查的附加工具，可大大提高诊断准确性。但是，诊断很大程度上取决于医师的经验。高清光学相干断层扫描（HD-OCT）似乎为黑素细胞病变提供了与RCM互补的其他结构和细胞信息。但是，如果基于形态学分析，HD-OCT的诊断潜力似乎不足以排除黑色素瘤的诊断。本文的目的是首先量化体内光学性质，例如通过HD-OCT对黑素细胞病变的光衰减。第二个目的是确定这些光学特性对黑素瘤诊断的最佳临界值。在对数连续的四个皮肤层（表皮，上乳头真皮，较深的乳头真皮和浅层网状真皮）发出的HD-OCT信号上实现了半对数绘图技术，使指数函数变为直线。这样就可以进行HD-OCT体内皮肤入口信号（SES）的测量，针对皮肤入口信号（µraf1）和半值层（z1 / 2）标准化的相对衰减因子。基于光学特性，μraf1，SES和z1 / 2的HD-OCT诊断黑素瘤的诊断准确性很高（分别为95.6％，82.2％和88.9％）。与单独进行形态学评估（89.9％）相比，可以发现这些光学特性的高阴性预测值（分别为96.7％，89.3％和96.3％），从而将将恶性病变误诊为更可接受的水平的风险降低了（3.3％，而不是11.1％） ％）。 HD-OCT似乎可以将细胞和3-D微体系结构的体内形态学分析与黑素细胞病变中组织散射体的光学特性的体内分析相结合。光学特性的体内HD-OCT分析比单独的体内HD-OCT形态分析能够更准确地诊断黑色素瘤。

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