Accuracy of tele-consultation on management decisions of lesions suspect for melanoma using reflectance confocal microscopy as a stand-alone diagnostic tool.
Academic Medical Centers
Adult
Aged
Biopsy, Needle
Cancer Care Facilities
Clinical Decision-Making
Dermoscopy
/ methods
Diagnosis, Differential
Female
Humans
Immunohistochemistry
Male
Melanoma
/ diagnostic imaging
Microscopy, Confocal
/ methods
Middle Aged
Nevus, Pigmented
/ diagnostic imaging
Remote Consultation
/ methods
Sensitivity and Specificity
Skin Neoplasms
/ diagnostic imaging
Journal
Journal of the European Academy of Dermatology and Venereology : JEADV
ISSN: 1468-3083
Titre abrégé: J Eur Acad Dermatol Venereol
Pays: England
ID NLM: 9216037
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
19
04
2018
accepted:
26
07
2018
pubmed:
23
9
2018
medline:
7
6
2019
entrez:
23
9
2018
Statut:
ppublish
Résumé
Diagnostic accuracy of reflectance confocal microscopy (RCM) as a stand-alone diagnostic tool for suspect skin lesions has not been extensively studied. Primary aim was to measure experts' accuracy in RCM-based management decisions. Secondary aim was to identify melanoma-specific RCM features. The study enrolled patients ≥18 years that underwent biopsy of skin lesions clinically suspected to be melanoma. One hundred lesions imaged by RCM were randomly selected from 439 lesions prospectively collected at four pigmented lesion clinics. The study data set included 23 melanomas, three basal cell and two squamous cell carcinomas, 11 indeterminate melanocytic lesions and 61 benign lesions including 50 nevi. Three expert RCM evaluators were blinded to clinical or dermoscopic images, and to the final histopathological diagnosis. Evaluators independently issued a binary RCM-based management decision, 'biopsy' vs. 'observation'; these decisions were scored against histopathological diagnosis, with 'biopsy' as the correct management decision for malignant and indeterminate lesions. A subset analysis of 23 melanomas and 50 nevi with unequivocal histopathological diagnosis was performed to identify melanoma-specific RCM features. Sensitivity, specificity and diagnostic accuracy were 74%, 67% and 70% for reader 1, 46%, 84% and 69% for reader 2, and 72%, 46% and 56% for reader 3, respectively. The overall kappa for management decisions was 0.34. Readers had unanimous agreement on management for 50 of the 100 lesions. Non-specific architecture, non-visible papillae, streaming of nuclei, coarse collagen fibres and abnormal vasculature showed a significant association with melanoma in the evaluation of at least two readers. Reflectance confocal microscopy tele-consultation of especially challenging lesions, based on image review without benefit of clinical or dermoscopy images, may be associated with limited diagnostic accuracy and interobserver agreement. Architectural and stromal criteria may emerge as potentially useful and reproducible criteria for melanoma diagnosis.
Sections du résumé
BACKGROUND
BACKGROUND
Diagnostic accuracy of reflectance confocal microscopy (RCM) as a stand-alone diagnostic tool for suspect skin lesions has not been extensively studied.
OBJECTIVE
OBJECTIVE
Primary aim was to measure experts' accuracy in RCM-based management decisions. Secondary aim was to identify melanoma-specific RCM features.
METHODS
METHODS
The study enrolled patients ≥18 years that underwent biopsy of skin lesions clinically suspected to be melanoma. One hundred lesions imaged by RCM were randomly selected from 439 lesions prospectively collected at four pigmented lesion clinics. The study data set included 23 melanomas, three basal cell and two squamous cell carcinomas, 11 indeterminate melanocytic lesions and 61 benign lesions including 50 nevi. Three expert RCM evaluators were blinded to clinical or dermoscopic images, and to the final histopathological diagnosis. Evaluators independently issued a binary RCM-based management decision, 'biopsy' vs. 'observation'; these decisions were scored against histopathological diagnosis, with 'biopsy' as the correct management decision for malignant and indeterminate lesions. A subset analysis of 23 melanomas and 50 nevi with unequivocal histopathological diagnosis was performed to identify melanoma-specific RCM features.
RESULTS
RESULTS
Sensitivity, specificity and diagnostic accuracy were 74%, 67% and 70% for reader 1, 46%, 84% and 69% for reader 2, and 72%, 46% and 56% for reader 3, respectively. The overall kappa for management decisions was 0.34. Readers had unanimous agreement on management for 50 of the 100 lesions. Non-specific architecture, non-visible papillae, streaming of nuclei, coarse collagen fibres and abnormal vasculature showed a significant association with melanoma in the evaluation of at least two readers.
CONCLUSIONS
CONCLUSIONS
Reflectance confocal microscopy tele-consultation of especially challenging lesions, based on image review without benefit of clinical or dermoscopy images, may be associated with limited diagnostic accuracy and interobserver agreement. Architectural and stromal criteria may emerge as potentially useful and reproducible criteria for melanoma diagnosis.
Identifiants
pubmed: 30242916
doi: 10.1111/jdv.15257
pmc: PMC6372323
mid: NIHMS989790
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
439-446Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : R44 CA058054
Pays : United States
Organisme : NIH/NCI Cancer Center Support Grant
ID : P30 CA008748
Organisme : NIH/NCI Cancer Center Support Grant
ID : 5R44CA058054-06
Informations de copyright
© 2018 European Academy of Dermatology and Venereology.
Références
J Am Acad Dermatol. 2005 Dec;53(6):979-85
pubmed: 16310058
J Invest Dermatol. 2007 Dec;127(12):2759-65
pubmed: 17657243
J Invest Dermatol. 2009 Jan;129(1):131-8
pubmed: 18633444
Arch Dermatol. 2008 Sep;144(9):1120-7
pubmed: 18794455
Arch Dermatol. 2008 Dec;144(12):1644-9
pubmed: 19075152
PLoS One. 2009;4(4):e5375
pubmed: 19404399
Arch Dermatol. 2009 May;145(5):618
pubmed: 19451524
J Invest Dermatol. 2010 Aug;130(8):2080-91
pubmed: 20393481
J Am Acad Dermatol. 2010 Sep;63(3):377-86; quiz 387-8
pubmed: 20708470
Australas J Dermatol. 2011 May;52(2):89-97
pubmed: 21605091
J Eur Acad Dermatol Venereol. 2012 May;26(5):578-90
pubmed: 21605173
J Am Acad Dermatol. 2012 Aug;67(2):194.e1-8
pubmed: 22030020
Dermatology. 2012;224(1):51-8
pubmed: 22433231
Ann Surg Oncol. 2013 Nov;20(12):3969-75
pubmed: 23851608
J Am Acad Dermatol. 2013 Dec;69(6):e295-300
pubmed: 24035553
J Am Acad Dermatol. 2014 Jan;70(1):131-41
pubmed: 24176521
Dermatol Pract Concept. 2013 Oct 31;3(4):19-27
pubmed: 24282659
Exp Dermatol. 2014 Jun;23(6):414-8
pubmed: 24750486
Dermatol Pract Concept. 2014 Jul 31;4(3):67-71
pubmed: 25126463
Br J Dermatol. 2016 Dec;175(6):1311-1319
pubmed: 27177158
J Am Acad Dermatol. 2016 Aug;75(2):356-63
pubmed: 27189823
JAMA Dermatol. 2016 Oct 1;152(10):1085-1087
pubmed: 27580064
Dermatol Clin. 2016 Oct;34(4):505-512
pubmed: 27692456
Folia Med Cracov. 2016;56(3):21-29
pubmed: 28275268
BMJ. 2017 Jun 28;357:j2813
pubmed: 28659278
PLoS One. 2017 Nov 9;12(11):e0187748
pubmed: 29121636
J Invest Dermatol. 1995 Jun;104(6):946-52
pubmed: 7769264