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Reflectance confocal microscopy (RCM) allows accurate, noninvasive, in vivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown.
We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions.
Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM.
We included 272 consecutive lesions from 226 individuals (mean age, 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P < .001) when RCM confirmed or changed the diagnosis. Lesion management changed in 33.5% cases after RCM (to observation in 51 cases and to biopsy/excision in 31 cases). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8% and 80%, respectively.
Small sample size, real-life environment, and different levels of expertise among RCM users.
Physicians' diagnostic confidence and accuracy increased after RCM when evaluating equivocal tumors, frequently resulting in management changes while maintaining high diagnostic accuracy.Le texte complet de cet article est disponible en PDF.
Key words : basal cell carcinoma, diagnostic accuracy, diagnostic confidence level, management, melanoma, reflectance confocal microscopy, skin cancer
Abbreviations used : BCC, NNE, RCM, SCC, SD
| Funding sources: Supported in part by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748 and personal grants to Dr Yélamos (by Beca Fundación Piel Sana) and Dr Carrera (by Hospital Clínic Barcelona for foreign research stay). Research and confocal imaging in the Melanoma Unit in Barcelona is partly funded by the Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras of the Instituto de Salud Carlos III, Spain, cofinanced by European Development Regional Fund “A way to achieve Europe” European Regional Development Fund (ERDF) and by the European Commission under the 7th Framework Programme (Diagnoptics).
| Disclosure: Dr Rajadhyaksha is a former employee of and owns equity in Caliber Imaging and Diagnostics (formerly Lucid Inc), the company that manufactures and sells the Vivascope confocal microscope. The Vivascope is the commercial version of an original laboratory prototype that he developed at Massachusetts General Hospital, Harvard Medical School. Drs Yélamos, Manubens, Jain, Chavez-Bourgeois, Pulijal, Dusza, Marchetti, Barreiro, Marino, Malvehy, Cordova, Rossi, Halpern, Puig, Marghoob, and Carrera have no conflicts of interest to declare.
| Reprints not available from the authors.