Optical coherence tomography of basal cell carcinoma: influence of location,subtype, observer variability and image quality on diagnostic performance |
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| Authors: | J Holmes T von Braunmühl C Berking E Sattler M Ulrich U Reinhold H Kurzen T Dirschka C Kellner S Schuh J Welzel |
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| Institution: | 1. Michelson Diagnostics Ltd, Maidstone, Kent, U.K.;2. University Hospital Munich, Department of Dermatology, Munich, Germany;3. Private Dermatology Office/CMB Collegium Medicum Berlin GmbH, Berlin, Germany;4. Dermatology Center Bonn Friedensplatz, Bonn, Germany;5. Private Dermatology Office, Freising, Germany;6. Private Dermatology Office, Wuppertal, Germany;7. St Bernard‐Hospital, Kamp Lintfort, Germany;8. General Hospital Augsburg, Department of Dermatology and Allergology, Augsburg, Germany |
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| Abstract: | Nonmelanoma skin cancer (NMSC) is the most common cancer affecting white‐skinned people worldwide, outnumbering all other cancers combined. Basal cell carcinoma (BCC) is the most common NMSC, with at least 100 000 new cases diagnosed in the UK each year, rising 4–10% every year, placing an ever‐increasing burden on healthcare services. At least 50% of skin biopsies for BCC are negative (no cancer tumour present) and so dermatologists wish for a non‐invasive imaging tool (i.e. using an image rather than biopsy surgery) that could provide more information to make a diagnosis to avoid unnecessary biopsies. This study of 256 BCC patients was performed at 6 centres based in Germany. The study examined the accuracy of diagnosis of BCC using a novel imaging device, the VivoSight Optical Coherence Tomography (OCT) scanner. A 2015 publication from this study (Ulrich et al., Brit. J. Dermatology, (15), 173, pp 428–435) reported that the accuracy of diagnosis using OCT was much improved over clinical/dermoscopic examination, in which a doctor examines the skin just by sight or using a handheld magnifier called a dermatoscope. In the present paper, the authors report on further analysis of the data: diagnostic performance – meaning the accuracy of the diagnosis – did not depend on where the lesion (affected patch of skin) was located on the body; that diagnostic performance was reduced when the lesion had scales/crusting (but was still superior to clinical/dermoscopic examination); that diagnostic performance was consistent between different medics (meaning their diagnoses were largely the same) and that they were more likely to be correct when they had high confidence in their diagnosis; and that BCC subtype can be diagnosed from OCT with moderate accuracy (62–72%). These conclusions support the targeted use of OCT to aid the diagnosis of BCC, potentially improving the standard of care by enabling more early‐stage BCCs to be detected and by supporting the use of non‐invasive treatment options. |
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