Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods
Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods
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DOI：
10.1111/j.1439-0507.2012.02198.x
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发表时间：
2013-01-01
期刊：
影响因子：
4.9
通讯作者：
Welzel, J.
中科院分区：
文献类型：
--
作者：
Rothmund, G.;Sattler, E. C.;Welzel, J.
甲真菌病是常见的，可以模仿几种不同的指甲疾病。准确的诊断是选择最佳抗真菌治疗的关键。本研究的目的是评估使用共聚焦激光扫描显微镜（CLSM）和光学相干断层扫描（OCT）作为新的非侵入性诊断工具在甲真菌病，并比较它们与既定的技术。在一项前瞻性试验中，50例疑似甲真菌病患者和10名对照者进行了CLSM和OCT检查，并行KOH制备、培养、PAS染色和PCR。PCR法的敏感性最高，CLSM法次之，PAS法和KOH法。OCT提供了第二好的灵敏度，但显示出最低的特异性。CLSM和KOH制备法的特异性较高，CLSM的阳性预测值最高，与KOH制备法和OCT相似;真菌培养法的敏感性最低，阴性预测值最差，而培养法和PCR是唯一能够鉴定真菌属和种的方法。总之，CLSM与PAS染色相当，并且上级优于KOH制备。由于特异性低，我们评估OCT不合适。在物种分化方面，PCR在时间和灵敏度方面优于真菌培养。
Onychomycosis is common and can mimic several different nail disorders. Accurate diagnosis is essential to choose the optimum antifungal therapy. The aim of this study was to evaluate the use of confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) as new non-invasive diagnostic tools in onychomycosis and to compare them with the established techniques. In a prospective trial, 50 patients with suspected onychomycosis and 10 controls were examined by CLSM and OCT. Parallel KOH preparation, culture, PAS-staining and PCR were performed. PCR showed the highest sensitivity, followed by CLSM, PAS and KOH preparation. OCT offered the second best sensitivity but displayed the lowest specificity. CLSM and KOH preparation showed a high specificity and CLSM offered the best positive predictive value, similar to KOH preparation and OCT. Fungal culture showed the lowest sensitivity and the worst negative predictive value, yet culture and PCR are the only techniques able to identify genus and species. In summary, CLSM was comparable to PAS staining and superior to KOH preparation. Due to the low specificity we assess OCT not as appropriate. In the differentiation of species PCR outplays the fungal culture in terms of time and sensitivity.