In Vivo Reflectance Confocal Microscopy as a Response Monitoring Tool for Actinic Keratoses Undergoing Cryotherapy and Photodynamic Therapy.
In Vivo Reflectance Confocal Microscopy as a Response Monitoring Tool for Actinic Keratoses Undergoing Cryotherapy and Photodynamic Therapy.
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DOI：
10.3390/cancers13215488
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发表时间：
2021-10-31
期刊：
影响因子：
5.2
通讯作者：
Hofmann-Wellenhof R
中科院分区：
文献类型：
--
作者：
Curiel-Lewandrowski C;Myrdal CN;Saboda K;Hu C;Arzberger E;Pellacani G;Legat FJ;Ulrich M;Hochfellner P;Oliviero MC;Pasquali P;Gill M;Hofmann-Wellenhof R
在预防和治疗试验以及临床实践中对光化性角化病 (AK) 的评估可以从非侵入性成像技术的结合中获益匪浅。这种技术有潜力增强临床和亚临床 AK 的客观评估，并具有序贯监测的额外优势。体内反射共焦显微镜 (RCM) 允许在细胞水平上对 AK 进行非侵入性成像。我们的目标是建立用于 AK 反应监测的体内 RCM 方案，最终实现更可靠的纵向反应表征和治疗优化。反射共焦显微镜 (RCM) 提供了一种在细胞水平上对光化性角化病 (AK) 进行成像的非侵入性方法。然而，不同研究的 AK 反应监测 RCM 标准各不相同，并且缺乏通用的标准化方法。我们的目的是确定可靠的 AK 反应标准，并比较不同 AK 严重程度等级反应的临床和 RCM 评估。 20 名患者被纳入研究并随机接受冷冻疗法 (n = 10) 或 PDT (n = 10)。在基线、3个月和6个月时对AK病变和光损伤皮肤进行12项标准的临床评估和RCM评估。我们确定了 RCM 标准，该标准能够可靠地描述基线 AK 的特征，并显示治疗后显着降低。基线优势比 (OR) 最高、观察者间一致性良好、随时间变化最显着的是非典型蜂窝状图案 (OR: 12.7, CI: 5.7–28.1)、角化过度 (OR: 13.6, CI: 5.3–34.9)、角质层破坏 (OR: 7.8, CI: 3.5–17.3) 和表皮图案紊乱（OR：6.5，CI：2.9–14.8）。临床评估显示治疗反应显着且无复发。然而，在 2 级 AK 中，10/12 RCM 参数从 3 个月增加到 6 个月，这表明 RCM 可以早期检测亚临床复发。纳入标准化 RCM 方案来评估 AK 可能会在临床试验之间进行更有意义的比较，同时允许及早发现复发并评估随时间推移对治疗的生物反应。
The assessment of actinic keratoses (AKs) in prevention and therapeutic trials, as well as clinical practice, could significantly benefit from the incorporation of non-invasive imaging technology. Such technology has the potential to enhance the objective evaluation of clinical and subclinical AKs with the added advantage of sequential monitoring. In vivo reflectance confocal microscopy (RCM) allows for the non-invasive imaging of AKs at a cellular level. We aimed to establish an in in vivo RCM protocol for AK response monitoring, ultimately leading to more reliable characterization of longitudinal responses and therapy optimization. Reflectance confocal microscopy (RCM) presents a non-invasive method to image actinic keratosis (AK) at a cellular level. However, RCM criteria for AK response monitoring vary across studies and a universal, standardized approach is lacking. We aimed to identify reliable AK response criteria and to compare the clinical and RCM evaluation of responses across AK severity grades. Twenty patients were included and randomized to receive either cryotherapy (n = 10) or PDT (n = 10). Clinical assessment and RCM evaluation of 12 criteria were performed in AK lesions and photodamaged skin at baseline, 3 and 6 months. We identified the RCM criteria that reliably characterize AK at baseline and display significant reduction following treatment. Those with the highest baseline odds ratio (OR), good interobserver agreement, and most significant change over time were atypical honeycomb pattern (OR: 12.7, CI: 5.7–28.1), hyperkeratosis (OR: 13.6, CI: 5.3–34.9), stratum corneum disruption (OR: 7.8, CI: 3.5–17.3), and disarranged epidermal pattern (OR: 6.5, CI: 2.9–14.8). Clinical evaluation demonstrated a significant treatment response without relapse. However, in grade 2 AK, 10/12 RCM parameters increased from 3 to 6 months, which suggested early subclinical recurrence detection by RCM. Incorporating standardized RCM protocols for the assessment of AK may enable a more meaningful comparison across clinical trials, while allowing for the early detection of relapses and evaluation of biological responses to therapy over time.
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影响因子：
3.6
作者：
Pasquali, Paola;Segurado-Miravalles, Gonzalo;Gonzalez, Salvador
通讯作者：
Gonzalez, Salvador
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