Abstract
Non-invasive diagnostic techniques in dermatology gained increasing popularity in the last decade. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) are meanwhile established in research and clinical routine. While OCT is mainly indicated for detecting non-melanoma skin cancer, RCM has proven its usefulness additionally in distinguishing melanocytic lesions. Line-field confocal optical coherence tomography (LC-OCT) is an emerging tool combining the principles of both above-mentioned methods. Healthy skin at different body sites and exemplary skin lesions (basal cell carcinoma, malignant melanoma, actinic keratosis) were examined using dermoscopy, RCM, OCT and LC-OCT. Standard features for RCM and OCT and comparable features for LC-OCT were analysed. LC-OCT has a lower penetration depth but superior resolution compared to OCT. In comparison with RCM, which provides only horizontal sections, LC-OCT creates both vertical and horizontal images in real time and has nearly the same cellular resolution. Our preliminary experiences suggest that LC-OCT combines the advantages of RCM and OCT, with optimal resolution and penetration depth to diagnose all types of skin cancer. Larger systematic studies are needed to further characterize the field of use of this device and its sensitivity and specificity compared to histology.
Highlights
Optical coherence tomography (OCT) is well established in non-invasive diagnostics, especially for epithelial skin tumours
Vertical mode is directly comparable with optical coherence tomography (OCT) images and histological sections, while en-face mode is overlapping with Reflectance confocal microscopy (RCM) images and dermoscopy
Line-field confocal optical coherence tomography (LC-OCT) penetration depth is inferior to OCT (500 μm to about 1.5 mm); this feature can play an important role in the evaluation of the vascular plexus and neoangiogenesis as well as the thickness of invasive tumours, where deeper parts and the lower border can be missed by LC-OCT
Summary
Optical coherence tomography (OCT) is well established in non-invasive diagnostics, especially for epithelial skin tumours. It enables the visualization of architectural changes down to the middle dermis, but without cellular resolution. Depth section images are displayed, whereby three-dimensional overview images are possible This allows basal cell carcinomas (BCCs) to be diagnosed and distinguished from other epithelial tumours and precancerous lesions. Line-field confocal optical coherence tomography (LC-OCT) allows the simultaneous display of horizontal and vertical images with a higher resolution than conventional OCT, and with a higher detection depth compared to RCM. A LC-OCT prototype (DAMAE, Paris) was used in this study to image healthy skin at different locations, to display a basal cell carcinoma, an actinic keratosis and a malignant melanoma exemplarily and to compare the findings with OCT and RCM. The intention was to evaluate the potential of LC-OCT in comparison to OCT and RCM regarding diagnosis of skin cancer.[8,9]
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