Abstract
Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers.
Highlights
Basal cell carcinoma (BCC) is the most prevalent skin cancer worldwide
In our sample of 123 lesions, reflectance confocal microscopy (RCM) detected BCC presence with a sensitivity of 97.1% and a specificity of 78.95% at a disease prevalence of 84.55%
If only conclusive RCM analysis results were included in the analysis (n = 121), RCM sensitivity was unchanged at 97.1%, but specificity was higher at 88.2%, as was disease prevalence (85.95%)
Summary
Basal cell carcinoma (BCC) is the most prevalent skin cancer worldwide. In Europe, BCC incidence has been constantly rising by approximately 5% annually over recent decades [1], causing a major burden on healthcare systems [2,3]. Current national and European guidelines [8,9] advise distinct therapeutic approaches of BCC based on tumor location, size, and histopathological subtype. With the increasing number of efficient non-surgical treatment options for superficial BCC (sBCC) [10], the histopathological subtype becomes of special interest in choosing the most appropriate management course [11,12,13,14]. Guidelines recommend BCC diagnosis confirmation and histological subtyping through a punch biopsy [15,16]. A punch biopsy fails to diagnose an aggressive BCC subtype in one out of six tumors [17]. Histopathological examination of the entire tumor specimen remains the most accurate approach of establishing BCC histopathological subtype [18,19,20]
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