远程皮肤共聚焦显微镜：一项评估三级环境中黑色素瘤和角质形成细胞癌诊断精度的多中性前瞻性研究
Remote cutaneous confocal microscopy: A multicentric prospective study evaluating diagnostic accuracy for melanoma and keratinocyte carcinoma in tertiary settings
影响因子:11.80000
分区:医学1区 Top / 皮肤病学1区
发表日期:2025 Feb
作者:
Genevieve Ho, Helena Collgros, Christoph Sinz, Bruna Melhoranse-Gouveia, Bruna Gallo, Christopher Y Chew, Ken Ip, James Koutsis, Serigne N Lo, Rodrigo Schwartz-Aldea, Hsien Herbert Chan, Peter Ferguson, Hannah Gribbin, Victoria Mar, Hans Peter Soyer, Linda K Martin, Andrea L Smith, Anne E Cust, Pascale Guitera
摘要
皮肤共聚焦显微镜（CCM）促进了细胞水平皮肤的体内可视化。使用“商店和前进”方法在跨多个站点进行远程CCM解释（远程CCM）尚未进行测试，并且可能会增加获得非侵入性诊断的访问权限。用于测试远程CCCM的诊断准确性和安全性，我们前瞻性招募的病变选择了5个澳大利亚第五级dermatiary Dermatory Centers的皮肤恶性肿瘤的活检。 CCM，临床和皮肤镜检查图像是获得了临时性的，并由基于云的平台访问了CCM读取器的解释。将CCM诊断与组织病理学结果进行了比较。在包括201个病变的情况下，黑色素瘤是最常见的恶性肿瘤（34/72，47.2％）。在有可能从活检中“保存”的89个病变（44.8％）中，有80个（90％）是真正的良性病变，而9（10.1％）遗漏了SINU（n = 7）和鳞状细胞癌（SCC）的恶性病变（n = 2）（n = 2）。没有错过侵入性黑色素瘤。远程CCM检测恶性肿瘤的敏感性为89％（95％CI，79％-95％），特异性为64％（95％CI，55％-73％）。这项研究是从高风险人群中招募的，是从高风险人群中招募的，并被排除在活检中的病变。Remote-CCM可以比较biopsied。潜在的SCC不适合远程CCM。建议对近端黑素细胞病变进行随访。
Abstract
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.To test the diagnostic accuracy and safety of remote-CCM.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.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%).The study recruited from high-risk populations and excluded lesions that were not biopsied.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.