Concordance of handheld reflectance confocal microscopy (RCM) with histopathology in the diagnosis of lentigo maligna (LM): A prospective study
Concordance of handheld reflectance confocal microscopy (RCM) with histopathology in the diagnosis of lentigo maligna (LM): A prospective study
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DOI：
10.1016/j.jaad.2015.12.045
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发表时间：
2016-06-01
影响因子：
13.8
通讯作者：
Rossi, Anthony M.
中科院分区：
文献类型：
--
作者：
Menge, Tyler D.;Hibler, Brian P.;Rossi, Anthony M.
背景资料：反射共聚焦显微镜（RCM）提供了实时的非侵入性成像的细胞结构，并可能是有用的，在诊断恶性雀斑样痣（LM）。很少有研究比较RCM与组织病理学诊断LM的性能，并影响RCM解释的具体功能没有很好地described.Objective：我们试图确定RCM和组织病理学之间的一致率在可疑LM的评价，并确定可能掩盖diagnosis.Methods的因素：我们设计了一项前瞻性研究，涉及17名参与者在一个大型三级转诊中心的评价。病例包括原发性病变和可能复发和/或既往治疗过的病变。共63个临床可疑的网站进行了评估，RCM和组织病理学。结果：RCM和组织病理学的解释是一致的，在56 63个网站（89%）。RCM法无假阴性，假阳性7例（敏感性100%，特异性71%，阳性预测值85%，阴性预测值100%）。在假阳性组中提示LM的特征包括在真皮表皮交界处存在大量高反射性大细胞和这些细胞的滤泡定位。局限性：需要更大的测试集来更可靠地使用RCM区分LM和良性病变并提高特异性。尽管在光化损伤的皮肤背景上的良性斑的特征可以模糊诊断并限制其特异性，但RCM显示出检测LM的极好的灵敏度。
Background: Reflectance confocal microscopy (RCM) provides real-time noninvasive imaging of cell structure and may be useful in diagnosing lentigo maligna (LM). Few studies have compared performance of RCM with histopathology in diagnosing LM, and specific features influencing RCM interpretation are not well described.Objective: We sought to determine concordance rate between RCM and histopathology in the evaluation of suspected LM and to identify factors that may obscure diagnosis.Methods: We designed a prospective study involving 17 participants seen for evaluation at a large tertiary referral center. Cases included primary lesions and possible recurrent and/or previously treated lesions. A total of 63 clinically equivocal sites were assessed by RCM and histopathology.Results: RCM and histopathology interpretations were concordant in 56 of 63 sites (89%). There were no false-negative and 7 false-positive results using RCM(sensitivity 100%, specificity 71%, positive predictive value 85%, negative predictive value 100%). Features suggestive of LM in the false-positive group included the presence of numerous hyperreflectile large cells at the dermoepidermal junction and follicular localization of these cells.Limitations: A larger test set is needed to more reliably distinguish LM from benign lesions using RCM and to improve specificity.Conclusion: RCM shows excellent sensitivity for detecting LM although features of benign macules on a background of actinically damaged skin can obscure diagnosis and limit its specificity.