远程皮肤共聚焦显微镜：多中心前瞻性研究评估三级医疗环境中黑色素瘤和角化细胞癌的诊断准确性

Remote cutaneous confocal microscopy: A multicentric prospective study evaluating diagnostic accuracy for melanoma and keratinocyte carcinoma in tertiary settings

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

影响因子:11.8

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

DOI: 10.1016/j.jaad.2024.09.051

摘要

皮肤共聚焦显微镜（CCM）技术能够在体内以细胞水平观察皮肤组织。采用“存储与转发”方式进行远程CCM解读（remote-CCM）在多个地点尚未广泛测试，但有望增加非侵入性诊断的可及性。本研究旨在评估远程CCM的诊断准确性和安全性。我们在澳大利亚五家三级皮肤科中心前瞻性招募了因疑似皮肤恶性肿瘤而需活检的病变。采集活检前的CCM、临床和皮肤镜图像，通过云平台供CCM解读人员分析，并将CCM诊断结果与组织病理学结果进行比较。在所纳入的201例病变中，黑色素瘤是最常见的恶性肿瘤（34/72，47.2%）。在潜在“避免”活检的89例病变中，有80例（90%）确认为良性，9例（10.1%）漏诊恶性，包括原位黑色素瘤（7例）和鳞状细胞癌（2例）。未漏诊任何侵袭性黑色素瘤。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%）。本研究在高风险人群中进行，排除未进行活检的病变。远程CCM的准确性可与床边CCM相媲美，能安全减少不必要的活检。潜在的SCC不适合远程CCM。建议对边界不明的黑色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.