In Vivo Confocal Microscopy for Diagnosis of Melanoma and Basal Cell Carcinoma Using a Two-Step Method: Analysis of 710 Consecutive Clinically Equivocal Cases
In Vivo Confocal Microscopy for Diagnosis of Melanoma and Basal Cell Carcinoma Using a Two-Step Method: Analysis of 710 Consecutive Clinically Equivocal Cases
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DOI：
10.1038/jid.2012.172
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发表时间：
2012-10-01
影响因子：
6.5
通讯作者：
Pellacani, Giovanni
中科院分区：
文献类型：
--
作者：
Guitera, Pascale;Menzies, Scott W.;Pellacani, Giovanni
我们描述了两种算法，以诊断基底细胞癌（BCC）和黑色素瘤（PMM）使用在体内反射共聚焦显微镜（RCM）。共710个连续的皮肤病变切除，以排除恶性肿瘤（216个痣，266个痣，119个基底细胞癌，67个色素沉着的面部斑疹，和42个其他皮肤肿瘤）进行了成像的RCM。将RCM特征与病理诊断相关联，以开发诊断算法。BCC算法定义的多变量分析的训练集（50%）和测试的其余情况下的诊断准确性是100%的敏感性，88.5%的特异性。阳性特征为极化细长特征、毛细血管扩张和卷曲血管、基底样结节和对应于水平裂隙的表皮阴影。阴性特征为不可见的乳头、表皮层排列紊乱和脑状窝。对训练集（不包括BCC）的多变量判别分析确定了MM诊断的7个独立显著特征。MM算法在测试集上的诊断准确率为87.6%灵敏度，70.8%特异性。RCM误诊的4例浸润性肿瘤均为痣样型。RCM是一种高度准确的非侵入性BCC诊断技术。MM诊断也实现了良好的诊断准确性，尽管黑素细胞肿瘤的罕见变体可能限制该算法的严格应用。
We describe two algorithms to diagnose basal cell carcinomas (BCCs) and melanomas (MMs) using in vivo reflectance confocal microscopy (RCM). A total of 710 consecutive cutaneous lesions excised to exclude malignancy (216 MMs, 266 nevi, 119 BCCs, 67 pigmented facial macules, and 42 other skin tumors) were imaged by RCM. RCM features were correlated with pathology diagnosis to develop diagnostic algorithms. The diagnostic accuracy of the BCC algorithm defined on multivariate analysis of the training set (50%) and tested on the remaining cases was 100% sensitivity, 88.5% specificity. Positive features were polarized elongated features, telangiectasia and convoluted vessels, basaloid nodules, and epidermal shadowing corresponding to horizontal clefting. Negative features were non-visible papillae, disarrangement of the epidermal layer, and cerebriform nests. Multivariate discriminant analysis on the training set (excluding the BCCs) identified seven independently significant features for MM diagnosis. The diagnostic accuracy of the MM algorithm on the test set was 87.6% sensitivity, 70.8% specificity. The four invasive MMs that were misdiagnosed by RCM were all of nevoid subtype. RCM is a highly accurate non-invasive technique for BCC diagnosis. Good diagnostic accuracy was achieved also for MM diagnosis, although rare variants of melanocytic tumors may limit the strict application of the algorithm.