Kivanc Kose1, Christi Alessi Fox2, Anthony Rossi1, Manu Jain1, Miguel Cordova1, Stephen W Dusza1, Moira Ragazzi3, Stefano Gardini4, Elvira Moscarella5, Alba Diaz6, Ramon Pigem7, Salvador Gonzalez8, Antoni Bennassar7, Cristina Carrera7,9, Caterina Longo4,10, Milind Rajadhyaksha1, Kishwer S Nehal1. 1. Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA. 2. Caliber I.D., Rochester, New York, USA. 3. Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy. 4. Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. 5. Dermatology Unit, University of Campania L Vanvitelli, Naples, Italy. 6. Pathology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 7. Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 8. Medicine and Medical Specialties Department, Alcalá de Henares University, Madrid, Spain. 9. Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Madrid, Spain. 10. Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy.
Abstract
BACKGROUND: Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. OBJECTIVE: To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. METHODS: An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. RESULTS: Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. LIMITATIONS: Small dataset, variability in mosaic quality between centers. CONCLUSION: Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
BACKGROUND: Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. OBJECTIVE: To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. METHODS: An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. RESULTS: Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. LIMITATIONS: Small dataset, variability in mosaic quality between centers. CONCLUSION: Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
Authors: C Longo; R Pampena; C Bombonato; S Gardini; S Piana; M Mirra; M Raucci; A Kyrgidis; G Pellacani; M Ragazzi Journal: Br J Dermatol Date: 2019-02-20 Impact factor: 9.302
Authors: Euphemia W Mu; Jesse M Lewin; Mary L Stevenson; Shane A Meehan; John A Carucci; Daniel S Gareau Journal: JAMA Dermatol Date: 2016-12-01 Impact factor: 10.282
Authors: Vinzent Kevin Ortner; Aditi Sahu; Miguel Cordova; Kivanc Kose; Saud Aleissa; Christi Alessi-Fox; Merete Haedersdal; Milind Rajadhyaksha; Anthony Mario Rossi Journal: J Biophotonics Date: 2020-12-28 Impact factor: 3.207