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Meta-Analysis
. 2018 Dec 4;12(12):CD013189.
doi: 10.1002/14651858.CD013189.

Optical coherence tomography for diagnosing skin cancer in adults

Lavinia Ferrante di Ruffano  1 , Jacqueline Dinnes, Jonathan J Deeks, Naomi Chuchu, Susan E Bayliss, Clare Davenport, Yemisi Takwoingi, Kathie Godfrey, Colette O'Sullivan, Rubeta N Matin, Hamid Tehrani, Hywel C Williams; Cochrane Skin Cancer Diagnostic Test Accuracy Group
Affiliations
Meta-Analysis

Optical coherence tomography for diagnosing skin cancer in adults

Lavinia Ferrante di Ruffano et al. Cochrane Database Syst Rev. .

Abstract

Background: Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Optical coherence tomography (OCT) is a microscopic imaging technique, which magnifies the surface of a skin lesion using near-infrared light. Used in conjunction with clinical or dermoscopic examination of suspected skin cancer, or both, OCT may offer additional diagnostic information compared to other technologies.

Objectives: To determine the diagnostic accuracy of OCT for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC), or cutaneous squamous cell carcinoma (cSCC) in adults.

Search methods: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles.

Selection criteria: We included studies of any design evaluating OCT in adults with lesions suspicious for invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC, compared with a reference standard of histological confirmation or clinical follow-up.

Data collection and analysis: Two review authors independently extracted data using a standardised data extraction and quality assessment form (based on QUADAS-2). Our unit of analysis was lesions. Where possible, we estimated summary sensitivities and specificities using the bivariate hierarchical model.

Main results: We included five studies with 529 cutaneous lesions (282 malignant lesions) providing nine datasets for OCT, two for visual inspection alone, and two for visual inspection plus dermoscopy. Studies were of moderate to unclear quality, using data-driven thresholds for test positivity and giving poor accounts of reference standard interpretation and blinding. Studies may not have been representative of populations eligible for OCT in practice, for example due to high disease prevalence in study populations, and may not have reflected how OCT is used in practice, for example by using previously acquired OCT images.It was not possible to make summary statements regarding accuracy of detection of melanoma or of cSCC because of the paucity of studies, small sample sizes, and for melanoma differences in the OCT technologies used (high-definition versus conventional resolution OCT), and differences in the degree of testing performed prior to OCT (i.e. visual inspection alone or visual inspection plus dermoscopy).Pooled data from two studies using conventional swept-source OCT alongside visual inspection and dermoscopy for the detection of BCC estimated the sensitivity of OCT as 95% (95% confidence interval (CI) 91% to 97%) and specificity of 77% (95% CI 69% to 83%).When applied to a hypothetical population of 1000 lesions at the mean observed BCC prevalence of 60%, OCT would miss 31 BCCs (91 fewer than would be missed by visual inspection alone and 53 fewer than would be missed by visual inspection plus dermoscopy), and OCT would lead to 93 false-positive results for BCC (a reduction in unnecessary excisions of 159 compared to using visual inspection alone and of 87 compared to visual inspection plus dermoscopy).

Authors' conclusions: Insufficient data are available on the use of OCT for the detection of melanoma or cSCC. Initial data suggest conventional OCT may have a role for the diagnosis of BCC in clinically challenging lesions, with our meta-analysis showing a higher sensitivity and higher specificity when compared to visual inspection plus dermoscopy. However, the small number of studies and varying methodological quality means implications to guide practice cannot currently be drawn.Appropriately designed prospective comparative studies are required, given the paucity of data comparing OCT with dermoscopy and other similar diagnostic aids such as reflectance confocal microscopy.

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Conflict of interest statement

LFR: nothing to declare. JD: nothing to declare. JJD: nothing to declare. NC: nothing to declare. SEB: nothing to declare. CD: nothing to declare. YT: nothing to declare. KG: nothing to declare. CO: nothing to declare. RNM: "my institution received a grant for a Barco NV commercially sponsored study to evaluate digital dermoscopy in the skin cancer clinic. My institution also received Oxfordshire Health Services Research Charitable Funds for carrying out a study of feasibility of using the Skin Cancer Quality of Life Impact Tool (SCQOLIT) in non melanoma skin cancer. I have received royalties for the Oxford Handbook of Medical Dermatology (Oxford University Press) and payment from the UK Photopheresis Society for a lecture on cutaneous graft versus host disease (October 2017). I have no conflicts of interest to declare that directly relate to the publication of this work." HT: nothing to declare. HCW: "I am director of the NIHR HTA Programme. HTA is part of the NIHR which also supports the NIHR systematic reviews programme from which this work is funded."

Clinical referees:

Julia Welzel: "I am one of the authors of one of the cited studies (Welzel 1998, excluded). This study was supported in part by Michelson Diagnostics. I participated for some years in an advisory board of Michelson Diagnostics, one of the suppliers of OCT systems." Nathalie de Carvalho is an author of a study awaiting classification (Olsen 2016).

Figures

1
1
Sample photographs of superficial spreading melanoma (left) and nodular melanoma (right). Copyright © 2010 Dr Rubeta Matin: reproduced with permission.
2
2
Sample photographs of basal cell carcinoma (left) and cutaneous squamous cell carcinoma (right). Copyright © 2012 Dr Rubeta Matin: reproduced with permission.
3
3
Swept‐source optical coherence tomography scanner (Michelson Diagnostics VivoSight Rx). Copyright © 2017 Guy's & St Thomas' Hospital Trust: reproduced with permission.
4
4
Optical coherence tomography (OCT) image of a 7 mm basal cell carcinoma (BCC) on the cheek showing several BCC cell nests (left hand star is above and to the left of a BCC nest) and the position of the 2 mm margin as drawn with a reflective ink pen (right hand star). The ink pen gives the appearance of increased reflectivity in the epidermis, and causes a fine vertical linear interference of the OCT signal of the skin, giving a unique OCT signature. In this case, the interference is also seen to mask the OCT signal from the dermis under the pen mark. Copyright © 2017 Guy's & St Thomas' Hospital Trust: reproduced with permission.
5
5
Optical coherence tomography (OCT) image of a nodular basal cell carcinoma (BCC) showing a basal nest centrally (star). The Dark halo appearance is due to a cleft region fully encompassing the nest and the presence of peripheral palisading. Copyright © 2013 Michelson Diagnostics Ltd: reproduced with permission.
6
6
Current clinical pathway for people with skin lesions.
7
7
PRISMA flow diagram.
8
8
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
9
9
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
10
10
Forest plot of threshold data that could not be pooled for the diagnosis of melanoma and atypical intraepidermal melanocytic variants (MM + Mis), invasive melanoma alone (MM), basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). CI: confidence interval; FN: false negative; FP: false positive; TN: true negative; TP: true positive.
11
11
Forest plot of tests: pooled data for the detection of basal cell carcinoma (BCC) using visual inspection, dermoscopy, and optical coherence tomography (OCT). CI: confidence interval; FN: false negative; FP: false positive; TN: true negative; TP: true positive.
12
12
Summary ROC plot of studies comparing optical coherence tomography (OCT) and visual inspection for the detection of basal cell carcinoma (BCC).
13
13
Summary ROC plot of studies comparing optical coherence tomography (OCT) and dermoscopy for the detection of basal cell carcinoma (BCC).
1
1. Test
Optical coherence tomography (OCT) attenuation coefficient 5.4 mmˉ¹ (malignant melanoma (MM) + melanoma in situ (MiS)).
2
2. Test
High‐definition optical coherence tomography (HD‐OCT) Gambichler score ≥ –1 (MM + MiS).
3
3. Test
HD‐OCT – Gambichler score ≥ –1 (MM).
4
4. Test
OCT observer diagnosis (basal cell carcinoma (BCC)).
5
5. Test
Visual inspection observer diagnosis (BCC).
6
6. Test
Dermoscopy observer diagnosis (BCC).
7
7. Test
OCT Berlin score ≥ 8 (BCC).
8
8. Test
OCT Berlin score ≥ 12 (BCC).
9
9. Test
OCT Berlin score ≥ 8 (cutaneous squamous cell carcinoma (cSCC)).
10
10. Test
OCT Berlin score ≥ 12 (cSCC).
See this image and copyright information in PMC

References

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