Sahu A, et al. - Authors measured the accuracy of a combined reflectance confocal microscopy–optical coherence tomography (RCM-OCT) device for detecting basal cell carcinoma (BCC) and deep margin assessment. For comprehensively diagnosing lesions suggestive of BCC and triaging for treatment, study findings suggested the prospective use of combined RCM-OCT imaging.

Methods

• Experts conducted a pilot study on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, NY.
• They enrolled these patients prospectively and consecutively in the study between January 1, 2017 and December 31, 2017.
• For previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC, patients underwent imaging, with the combined RCM-OCT probe.
• They included only patients with available histopathologic examination after imaging.
• They gauged the improvements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth.

Results

• In total, 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were included, and 85 lesions were imaged.
• They performed imaging on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions.
• Findings suggested a correlation of normal skin and BCC features and these were validated with histopathologic examination.
• Residual tumors in previously biopsied lesions were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe.
• In 48 of 60 (80%) lesions in previously nonbiopsied and suspicious lesions, BCCs were diagnosed with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%).
• Depth estimated with OCT was correlated to the depth measured with histopathologic examination: the coefficient of determination (R²) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 μm deep, and 0.65 (R=0.43;P < .001) for lesions greater than 500 μm deep.