Remote cutaneous confocal microscopy: A multicentric prospective study evaluating diagnostic accuracy for melanoma and keratinocyte carcinoma in tertiary settings - 05/11/24

Doi : 10.1016/j.jaad.2024.09.051

Genevieve Ho, MD ^a,^b,^c,^⁎ , Helena Collgros, MD ^b,^d, Christoph Sinz, MD ^a,^b, Bruna Melhoranse-Gouveia, MD, MPhil ^a,^b, Bruna Gallo, MD ^a,^d, Christopher Y. Chew, MBBS ^e,^f,^g, Ken Ip, MBChB ^e, James Koutsis, MBBS ^a, Serigne N. Lo, PhD ^a,^b, Rodrigo Schwartz-Aldea, MD ^a, Hsien Herbert Chan, DPhil ^h, Peter Ferguson, MBChB, PhD ^a,^b,ⁱ, Hannah Gribbin, MD ^h,^j, Victoria Mar, MD, PhD ^e,^k, Hans Peter Soyer, MD ^h,^j, Linda K. Martin, MBBS ^a,^c,^l, Andrea L. Smith, PhD ^l, Anne E. Cust, PhD ^a,^l, Pascale Guitera, MD, PhD ^a,^b,^d
^a Melanoma Institute Australia, The University of Sydney, Sydney, Australia
^b Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
^c Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
^d Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
^e Victorian Melanoma Service, The Alfred Hospital, Melbourne, Australia
^f Cancer Treatment and Development Laboratory, Central Clinical School, Monash University, Melbourne, Australia
^g Shackleton Laboratory, University of Melbourne, Melbourne, Australia
^h Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
ⁱ Department of Tissue and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
^j Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Australia
^k School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
^l The Daffodil Centre, The University of Sydney, A Joint Venture with The Cancer Council NSW, Sydney, Australia

^∗Correspondence to: Genevieve Ho, MD, Melanoma Institute Australia, The Poche Centre, 40 Rocklands Road, Wollstonecraft, NSW 2065, Australia.Melanoma Institute AustraliaThe Poche Centre40 Rocklands RoadWollstonecraftNSW2065Australia

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Tuesday 05 November 2024
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Abstract

Background

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.

Objectives

To test the diagnostic accuracy and safety of remote-CCM.

Methods

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.

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%).

Limitations

The study recruited from high-risk populations and excluded lesions that were not biopsied.

Conclusions

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.

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Key words : cutaneous confocal microscopy, cutaneous imaging, cutaneous oncology, diagnostic accuracy, melanoma, nonmelanoma skin cancer, reflectance confocal microscopy, teledermatology

Abbreviations used : CCM, MIS, NNE, SCC

Esquema

Introduction

Methods

Study design and participants

Clinicopathologic correlation

Associations with accuracy

Management appropriateness

Diagnostic safety

Reporting agreement and time

Discussion

Limitations

Conclusions

Funding sources: Dr Ho was supported by the NHMRC CRE 1135285, MIA PhD top-up scholarship and Avant Foundation Early Career Research Program. Dr Cust was supported by a NHMRC Investigator Grant 2008454. Dr Melhoranse-Gouveia was supported by Melanoma Institute Australia scholarship for PhD students and top-up scholarship from Australian Melanoma Foundation. Dr Martin was supported by the Warwick L Morison Professorship in Dermatology, University of New South Wales.

IRB approval status: Reviewed and approved by Sydney Local Health District, Royal Prince Alfred Hospital Human Research Ethics Committee, Protocol X21-0260.