Biopsy outperforms reflectance confocal microscopy in diagnosing and subtyping basal cell carcinoma: results and experiences from a randomized controlled multicentre trial.

Autor: Woliner-van der Weg W; Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands., Peppelman M; Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands., Elshot YS; Department of Dermatology, Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands., Visch MB; Department of Dermatology, Rijnstate Hospital, Arnhem, the Netherlands., Crijns MB; Department of Dermatology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Alkemade HAC; Department of Dermatology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands., Bronkhorst EM; Department of, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands., Adang E; Department of, Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands., Amir A; Department of, Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands., Gerritsen MJP; Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands., van Erp PEJ; Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands., Lubeek SFK; Departments of, Department of, Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Jazyk: angličtina
Zdroj: The British journal of dermatology [Br J Dermatol] 2021 Apr; Vol. 184 (4), pp. 663-671. Date of Electronic Publication: 2020 Sep 02.
DOI: 10.1111/bjd.19381
Abstrakt: Background: Reflectance confocal microscopy (RCM) is a noninvasive method for skin assessment, allowing entire lesion evaluation up to the papillary dermis. RCM is a potentially attractive alternative to punch biopsy (PB) in basal cell carcinoma (BCC).
Objectives: To determine the diagnostic accuracy of RCM vs. PB in diagnosing and subtyping BCC, and to study patient satisfaction and preferences.
Methods: Patients with a clinically suspected primary BCC were randomized between RCM and biopsy. Conventional surgical excision or follow-up were used as reference. Sensitivity and specificity for BCC diagnosis and subtyping were calculated for both methods. BCC subtype was stratified based on clinical relevance: aggressive (infiltrative/micronodular) vs. nonaggressive (superficial/nodular) histopathological subtype and superficial vs. nonsuperficial BCC. Data on patient satisfaction and preferences were collected using a questionnaire and a contingent valuation method.
Results: Sensitivity for BCC diagnosis was high and similar for both methods (RCM 99·0% vs. biopsy 99·0%; P = 1·0). Specificity for BCC diagnosis was lower for RCM (59·1% vs. 100·0%; P < 0·001). Sensitivity for aggressive BCC subtypes was lower for RCM (33·3% vs. 77·3%; P = 0·003). Sensitivity for nonsuperficial BCC was not significantly different (RCM 88·9% vs. biopsy 91·0%; P = 0·724). Patient satisfaction and preferences were good and highly comparable for both methods.
Conclusions: Biopsy outperforms RCM in diagnosing and subtyping clinically suspected primary BCC. This outcome does not support routine clinical implementation of RCM, as a replacement for PBs in this patient group.
(© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)
Databáze: MEDLINE
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