Remote cutaneous confocal microscopy: A multicentric prospective study evaluating diagnostic accuracy for melanoma and keratinocyte carcinoma in tertiary settings - 17/01/25
, Helena Collgros, MD b, d, Christoph Sinz, MD a, b, Bruna Melhoranse-Gouveia, MD, MPhil a, b, Bruna Gallo, MD a, d, Christopher Y. Chew, MBBS e, f, g, Ken Ip, MBChB e, James Koutsis, MBBS a, Serigne N. Lo, PhD a, b, Rodrigo Schwartz-Aldea, MD a, Hsien Herbert Chan, DPhil h, Peter Ferguson, MBChB, PhD a, b, i, Hannah Gribbin, MD h, j, Victoria Mar, MD, PhD e, k, Hans Peter Soyer, MD h, j, Linda K. Martin, MBBS a, c, l, Andrea L. Smith, PhD l, Anne E. Cust, PhD a, l, Pascale Guitera, MD, PhD a, b, dAbstract |
Background |
Cutaneous confocal microscopy (CCM) facilitates in vivo visualization of skin at a cellular level. Use of a “store and forward” approach for remote-CCM interpretation (remote-CCM) across multiple sites has not been tested and may increase access to noninvasive diagnosis.
Objectives |
To test the diagnostic accuracy and safety of remote-CCM.
Methods |
We prospectively recruited lesions selected for biopsy for skin malignancy across 5 Australian tertiary dermatology centers. CCM, clinical and dermatoscopy images were acquired prebiopsy and accessed by a cloud-based platform for interpretation by CCM readers. CCM diagnosis was compared with histopathology results.
Results |
Among the 201 lesions included, melanoma was the most common malignancy (34/72, 47.2%). Of the 89 lesions (44.8%) potentially “saved” from biopsy, 80 (90%) were truly benign lesions and 9 (10.1%) were missed malignant lesions of melanoma in situ (n = 7) and squamous cell carcinoma (SCC) (n = 2). No invasive melanomas were missed. Sensitivity of remote-CCM for detection of malignancy was 89% (95% CI, 79%-95%) and specificity was 64% (95% CI, 55%-73%).
Limitations |
The study recruited from high-risk populations and excluded lesions that were not biopsied.
Conclusions |
Remote-CCM has comparable accuracy to bedside CCM and safely reduces unnecessary biopsies. Potential SCCs are not appropriate for remote-CCM. Follow-up of borderline melanocytic lesions is recommended.
Le texte complet de cet article est disponible en PDF.Key words : cutaneous confocal microscopy, cutaneous imaging, cutaneous oncology, diagnostic accuracy, melanoma, nonmelanoma skin cancer, reflectance confocal microscopy, teledermatology
Abbreviations used : CCM, MIS, NNE, SCC
Plan
| Funding sources: Dr Ho was supported by the NHMRC CRE 1135285, MIA PhD top-up scholarship and Avant Foundation Early Career Research Program. Dr Cust was supported by a NHMRC Investigator Grant 2008454. Dr Melhoranse-Gouveia was supported by Melanoma Institute Australia scholarship for PhD students and top-up scholarship from Australian Melanoma Foundation. Dr Martin was supported by the Warwick L Morison Professorship in Dermatology, University of New South Wales. |
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| IRB approval status: Reviewed and approved by Sydney Local Health District, Royal Prince Alfred Hospital Human Research Ethics Committee, Protocol X21-0260. |
Vol 92 - N° 2
P. 252-260 - février 2025 Retour au numéro
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