Elisa Cinotti

Diagnostic Accuracy of Line-Field Confocal Optical Coherence Tomography for the Diagnosis of Skin Carcinomas

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Line-field confocal optical coherence tomography (LC-OCT) is a new, noninvasive imaging technique for the diagnosis of skin cancers. A total of 243 benign (54%) and malignant (46%) skin lesions were consecutively enrolled from 27 August 2020, to 6 October 2021 at the Dermatology Department of the University Hospital of Siena, Italy. Dermoscopic- and LC-OCT-based diagnoses were given by an expert dermatologist and compared with the ground truth. Considering all types of malignant skin tumours (79 basal cell carcinomas (BCCs), 22 squamous cell carcinomas, and 10 melanomas), a statistically significant increase (p = 0.013) in specificity was observed from dermoscopy (0.73, CI 0.64–0.81) to LC-OCT (0.87, CI 0.79–0.93) while sensitivity was the same with the two imaging techniques (0.95 CI 0.89–0.98 for dermoscopy and 0.95 CI 0.90–0.99 for LC-OCT). The increase in specificity was mainly driven by the ability of LC-OCT to differentiate BCCs from other diagnoses. In conclusion, our real-li...

Comparison of reflectance confocal microscopy and line-field optical coherence tomography for the identification of keratinocyte skin tumours

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Background: Reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT) are non-invasive imaging devices that can help in the clinical diagnosis of actinic keratosis (AK) and cutaneous squamous cell carcinoma (SCC). No studies are available on the comparison between these two technologies for the identification of the different features of keratinocyte skin tumours. Objectives: To compare RCM and LC-OCT findings in AK and SCC. Methods: A retrospective multicenter study was conducted. Tumours were imaged with RCM and LC-OCT devices before surgery, and the diagnosis was confirmed by histological examinations. LC-OCT and RCM criteria for AK/SCC were identified, and their presence/absence was evaluated in all study lesions. Gwet AC1 concordance index was calculated to compare RCM and LC-OCT. Results: We included 52 patients with 33 AKs and 19 SCCs. Irregular epidermis was visible in most tumours and with a good degree of agreement between RCM and ...

Morphologic evaluation of melanocytic lesions with three-dimensional line-field confocal optical coherence tomography: correlation with histopathology and reflectance confocal microscopy. A pilot study

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Background Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging technique which provides cellular resolution, imaging depth (400 μm) and produces real-time images in both the horizontal and vertical plane and in 3 dimensions (3D). No previous description of different subtypes of melanocytic lesions and their correlation with histopathology and reflectance confocal microscopy has been reported. Objectives We aimed to describe the features of melanocytic lesions by LC-OCT and their correlation with histopathology and reflectance confocal microscopy (RCM). Methods Selected melanocytic benign lesions and melanomas were imaged in vivo with RCM and LC-OCT at the Hospital Clinic of Barcelona. A minimum area of 4mm x 4mm (block image) at 4 depths (stratum granulosum, suprabasal, dermoepidermal-junction and upper dermis) were acquired with RCM and a minimum of 3 cubes with LC-OCT. Horizontal, vertical sections and 3D cubes of LC-OCT were matched with RCM Viv...

Line-field confocal optical coherence tomography (LC-OCT) as a new tool for non-invasive differential diagnosis of pustular skin disorders

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Background: The spectrum of pustular skin disorders (PSD) is large and particularly challenging, including inflammatory, infectious and amicrobial diseases. Moreover, although pustules represent the unifying clinical feature, they can be absent or not fully developed in the early stage of the disease. The line-field confocal optical coherence tomography (LC-OCT) is a recently developed imaging technique able to perform a non-invasive, in vivo, examination of the epidermis and upper dermis, reaching very high image resolution and virtual histology. Objectives: We aimed to investigate the potentialities of LC-OCT in the non-invasive differential diagnosis of a series of 11 PSD with different etiology, microscopic features, body location and incidence rates. Materials and methods: Complete LC-OCT imaging (i.e., 2D/3D frames, videos) was performed on a total of 19 patients (10 females and 9 males) aged between 35 and 79 years. Images were blindly evaluated and compared with correspondin...

Acquired digital fibrokeratoma: First observation by high-resolution skin ultrasound and line-field confocal optical coherence tomography

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High-resolution skin ultrasound was performed in Siena University Hospital (Italy) with a 10–22 MHz linear probe (MyLab Twice-Esaote biomedica®, Firenze, Italy) up to 3mm depth. 3 Examination of the base [ Figure 1 ] revealed an oval, homogeneously hyperechogenic structure within the epidermal layer (E), surrounded by two hyperechoic parallel bands due to the hyperkeratotic collarette, with a well-defined posterior shadow cone reaching the papillary dermis and reticular dermis [ Figure 2 ]. The lesion was totally excised for histopathologic examination, confirming the suspicion of acquired digital fibrokeratoma [ Figures 5 - 7 ]. The clinical-pathological classification proposed by Kint et al . includes a type I (i.e., dome-shaped lesion containing collagen bundles, elastic fibres and large capillaries), a type II (i.e., an elongated hyperkeratotic lesion mainly composed by collagen bundles with few elastic fibres), and a type III acquired digital fibrokeratoma (i.e., a fl...

Non-invasive scoring of cellular atypia in keratinocyte cancers in 3D LC-OCT images using Deep Learning

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Diagnosis based on histopathology for skin cancer detection is today's gold standard and relies on the presence or absence of biomarkers and cellular atypia. However it suffers drawbacks: it requires a strong expertise and is time-consuming. Moreover the notion of atypia or dysplasia of the visible cells used for diagnosis is very subjective, with poor inter-rater agreement reported in the literature. Lastly, histology requires a biopsy which is an invasive procedure and only captures a small sample of the lesion, which is insufficient in the context of large fields of cancerization. Here we demonstrate that the notion of cellular atypia can be objectively defined and quantified with a non-invasive in-vivo approach in three dimensions (3D). A Deep Learning (DL) algorithm is trained to segment keratinocyte (KC) nuclei from Line-field Confocal Optical Coherence Tomography (LC-OCT) 3D images. Based on these segmentations, a series of quantitative, reproducible and biologically relevant...

Line-field confocal optical coherence tomography of actinic keratosis: a case series

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Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive imaging technique that was recently developed, combining high penetration depth (up to 500-µm, approaching that of conventional OCT) with high isotropic resolution [lateral: 1.3 µm; axial: 1.1 µm - similar to that of reflectance confocal microscopy (RCM)]. 1 . ( Read Full Article )

Line-field confocal optical coherence tomography of sebaceous hyperplasia: a case series

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Line-field confocal optical coherence tomography (LC-OCT) is a newly developed non-invasive imaging technique that combines high penetration depth (500 µm, similar to conventional OCT) with high isotropic resolution (lateral 1.3 µm, axial 1.1 µm, similar to reflectance confocal microscopy [RCM]). 1 Moreover, with its ability to produce images in both vertical and horizontal planes, it enables a tridimensional (3D) analysis of the skin, which can prove very useful for assessing physiological 2 as well as pathological skin. ( Read Full Article )

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