In vivo confocal microscopy in clinical practice: comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader

J Am Acad Dermatol. 2013 Dec;69(6):e295-300. doi: 10.1016/j.jaad.2013.07.022. Epub 2013 Sep 13.

Abstract

Background: Reflectance confocal microscopy (RCM) is an imaging tool that allows the visualization of cellular details without biopsy. To our knowledge, RCM sensitivity and specificity has not been studied in a telemedicine setting.

Objective: We sought to assess RCM diagnostic accuracy in a support teleconsultation setting.

Methods: Between June 2010 and September 2011, 340 lesions were imaged using a confocal scanning microscope. The images were evaluated by 2 readers, one on site, and the other at a distance.

Results: A total of 334 cases were included. For each reader the sensitivity was greater than 90% and specificity for each reader was greater than 60%. Both readers had a combined sensitivity of 98.6% and 44% specificity.

Limitations: RCM may be limited in the correct classification of epithelial tumors.

Conclusions: RCM is a tool in the clinical diagnosis of skin lesions, providing a high diagnostic accuracy in teleconsultation use.

Keywords: AK; BCC; MM; RCM; SCC; SK; actinic keratosis; basal cell carcinoma; cutaneous lesions; malignant melanoma; noninvasive imaging; reflectance confocal microscopy; seborrheic keratosis; squamous cell carcinoma; teledermatology.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Competence*
  • Dermatology*
  • Humans
  • Microscopy, Confocal / methods
  • Microscopy, Confocal / standards
  • Point-of-Care Systems
  • Reproducibility of Results
  • Skin Diseases / pathology*
  • Telepathology*