The bedside diagnostic accuracy of a novice reflectance confocal microscopy reader for skin cancer detection in vivo in real-time: Understanding challenges and potential pitfalls Conference Paper
| Authors: | Jain, M.; Pulijal, S. V.; Rajadhyaksha, M. |
| Editors: | Alfano, R. R.; Demos, S. G. |
| Title: | The bedside diagnostic accuracy of a novice reflectance confocal microscopy reader for skin cancer detection in vivo in real-time: Understanding challenges and potential pitfalls |
| Conference Title: | Optical Biopsy XV: Toward Real-Time Spectroscopic Imaging and Diagnosis |
| Abstract: | Reflectance confocal microscopy (RCM) is a non-invasive device that images skin lesions in vivo at a cellular resolution to guide management of patient care. While previous studies have demonstrated high accuracy of RCM in diagnosing skin cancers, most of these studies were performed by experts as a blinded analysis off-site and does not reflect true clinical scenario. We assessed the diagnostic potential of a novice RCM reader, in clinical settings, at the bedside. Over a period of 15 months (August 2015- November 2016), 168 lesions (from 128 cases) were imaged with RCM to determine BCC and or melanoma in dermoscopically equivocal lesions. To evaluate the learning curve of the novice reader, diagnostic accuracy was evaluated at the end of 15 months, as well as during the first half (8 months) and latter half (seven months) of the study. Histopathological diagnosis was available in 95/168 lesions, including 38 melanocytic lesions (ML: 13 melanomas and 25 nevi) and 57 non-melanocytic lesions (NML: 26 BCCs, 4 SCCs and 27 benign). The remaining 73/168 lesions (43.45%) were not biopsied (received topical treatment, monitoring). On RCM, 22/26 (84.61%) BCCs and 11/13 (84.61%) melanomas were correctly diagnosed. BCC was missed in 3/26 (11.53%) lesions and melanoma in 2/13 (15.38%) lesions; these lesions were diagnosed mostly as superficial BCCs and focal epidermal changes overlying deeply situated melanoma nodule on histopathology, respectively. False positive diagnosis of BCC was obtained in 7/23 (30.4%) lesions and of melanoma in 2/22 (4.5%) lesions; these were diagnosed mostly as benign inflamed keratosis and moderately atypical dysplastic nevus on histopathology, respectively. In 7 lesions BCC or melanoma could not be ruled out. A marked increase in the sensitivity and specificity was noticed between the two halves of the study. An overall high diagnostic accuracy of 80.28% with high sensitivity and specificity of 80.68% and 80.8%, respectively in diagnosing skin cancers was obtained. Based on this study, we identified some current limitations and potential pitfalls of RCM. The fact that the diagnostic accuracy of the novice reader increased with time, indicates a learning curve reading RCM images. Additionally, current technical limitations of RCM such as inability to differentiate various cell types, sampling error, and, shallow depth of imaging also lead to false diagnosis. Efforts are ongoing to overcome these challenges by building US based teaching-training program and through a multimodal imaging approach for better diagnosis and patient care. © 2017 SPIE. |
| Keywords: | histopathology; diagnostic accuracy; reflectance confocal microscopy; confocal microscopy; patient monitoring; oncology; biopsy; reflectance confocal microscopies; reflection; in-vivo imaging; dermatology; diseases; skin cancers; in vivo imaging; bedside diagnostic accuracy; novice reader; program diagnostics |
| Journal Title | Progress in Biomedical Optics and Imaging - Proceedings of SPIE |
| Volume: | 10060 |
| Conference Dates: | 2017 Jan 31-Feb 1 |
| Conference Location: | San Francisco, CA |
| ISBN: | 1605-7422 |
| Publisher: | SPIE |
| Date Published: | 2017-01-28 |
| Start Page: | 1006002 |
| Language: | English |
| DOI: | 10.1117/12.2255685 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Conference Paper -- Export Date: 2 June 2017 -- Source: Scopus |
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3Pulijal
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