J. Welzel

2021 international consensus statement on optical coherence tomography for basal cell carcinoma: image characteristics, terminology and educational needs

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Background: Despite the widespread use of optical coherence tomography (OCT) for imaging of keratinocyte carcinoma, we lack an expert consensus on the characteristic OCT features of basal cell carcinoma (BCC), an internationally vetted set of OCT terms to describe various BCC subtypes, and an educational needs assessment. Objectives: To identify relevant BCC features in OCT images, propose terminology based on inputs from an expert panel and identify content for a BCC-specific curriculum for OCT trainees. Methods: Over three rounds, we conducted a Delphi consensus study on BCC features and terminology between March and September 2020. In the first round, experts were asked to propose BCC subtypes discriminable by OCT, provide OCT image features for each proposed BCC subtypes and suggest content for a BCC-specific OCT training curriculum. If agreement on a BCC-OCT feature exceeded 67%, the feature was accepted and included in a final review. In the second round, experts had to re-eva...

Line-field optical coherence tomography: In vivo diagnosis of basal cell carcinoma subtypes compared to histopathology

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Background: Basal cell carcinoma (BCC) is the most common skin cancer in the general population. Treatments vary from Mohs surgery to topical therapy, depending on the subtype. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have gained a foothold in daily clinical practice to optimize diagnosis and subtype-oriented treatment. The new device Line-field confocal OCT (LC-OCT) allows imaging at high resolution and depth but its use is not yet been investigated in larger studies. Objectives: To evaluate the main LC-OCT criteria for the diagnosis and subtyping of BCC in comparison to histopathology, OCT and RCM. Methods: Fifty-two histopathologically confirmed BCCs were evaluated for imaging criteria. Their frequency, predictive values and ROC curves were calculated. A multinominal regression with stepwise variables selection to distinguish BCC subtypes was performed. Results: Nodular BCCs were mainly characterized by atypical keratinocytes, alter...

Dynamic optical coherence tomography shows alterations of blood vessels characteristic for malignant melanoma

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Background Dynamic optical coherence tomography (D‐OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumors. Vessel patterns in malignant melanoma may be associated with tumor stage. Objective The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. Methods 159 malignant melanomas were assessed in a multicenter study. Every tumor was imaged using D‐OCT prior to surgery and histologic evaluation. The tumor data like thickness and ulceration as well as the staging at primary diagnosis and a follow‐up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to pre‐defined categories, compared to healthy adjacent skin and correlated to stage. Results Melanomas contained more blood vessels in different patterns compared to healthy adjacent skin. In particular, irregular vascular shapes like blobs, coils, curves and serpiginous vessels were more common in melanomas....

The vascular morphology of melanoma is related to Breslow index: an in vivo study with dynamic optical coherence tomography

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Background Malignant melanoma is an aggressive skin cancer, which can lead to metastasis development. Vascularization enhancement is fundamental for tumor growth, worsening the prognosis. Dynamic Optical Coherence Tomography (D‐OCT) enables the in vivo evaluation of vascular patterns in skin lesions. Objective In vivo evaluation of the melanoma vessel morphology by means of D‐OCT and correlation with Breslow index. Methods Retrospective analysis of histologically proven melanomas, evaluated by D‐OCT at three different depths (150, 300 and 500 μm) was performed. Vessels were classified according to morphology (dots, blobs, coiled, line, curved, serpiginous), distribution (regular, irregular), and presence/type of branches. The data were correlated with Breslow thickness. Results A total of 127 melanomas were evaluated. Dotted vessels were recorded at all depths, and their irregular distribution was associated with lesions thicker than 1.0 mm (from 75 to 91%), compared with thin ones ...

Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance

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Background We previously described the principal results from an observational, prospective, multi-centre, clinical trial of the diagnostic value of optical coherence tomography (OCT) for basal cell carcinoma (BCC) in a clinical setting. In this trial, much additional useful information was gathered that warranted further analysis, presented here. Objectives To investigate the influence of candidate diagnostic criteria, OCT image quality, lesion location, and observer confidence and inter-observer variability on the diagnostic performance, and to assess potential for diagnosis of BCC subtypes. Methods A total of 234 clinically unclear “pink lesions” were evaluated in three steps: after clinical examination, after adding dermoscopy and finally after adding OCT. In addition to the diagnoses (including lesion subtype), observers also recorded which of 15 diagnostic criteria the OCT image contained, their confidence in the diagnoses, the OCT image quality, and the anatomical location of...

Optical coherence tomography for margin definition of basal cell carcinoma before micrographic surgery—recommendations regarding the marking and scanning technique

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Background/purpose Mohs Micrographic Surgery (MMS) is the preferred therapeutic treatment for high-risk basal cell carcinoma (BCC). Optical Coherence Tomography (OCT) is a non-invasive imaging technique that enables the diagnosis of BCC. We thought to determine the margins of BCCs with OCT, prior to MMS, to reduce the number of surgical steps. Methods Different permanent markers were tested on the skin regarding line width, resistance against disinfection and brightness in the OCT image. The visible tumor margins of BCCs were defined by dermoscopy, adding a safety margin of 2 mm and labeled using the selected pen, causing a signal shadow in OCT. Scans of the center and of entire margin were performed. If parts of the BCC were visible outside the margin, another 2 mm were added and the scan was repeated until the tissue outside the labeling looked tumor free. Results Eight out of ten BCCs were totally excised in a single stage when margin delineation was done by OCT. Macroscopic marg...

Dynamic optical coherence tomography of skin blood vessels – proposed terminology and practical guidelines

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Background Dynamic optical coherence tomography (D-OCT) has recently been introduced in dermatology. In contrast to ‚Standard’ OCT imaging, which exclusively relies on the morphological analysis of the tissue, D-OCT allows the in-vivo visualisation of blood flow. Preliminary D-OCT data showed differences in the vascularisation of nevus to melanoma transition, suggesting that this technology may help to differentiate between benign and malignant lesions. Objective Several factors may influence the quality of D-OCT imaging. Therefore, standard operating procedures as well as a common terminology are required for better validation and comparison of the images. Methods Here we present practical guidelines for optimal image acquisition and a proposed terminology on vascular patterns observed by D-OCT. Results Dynamic OCT allows the morphologic distinction of different vascular shapes (e.g. dots, blobs, curves, lines), their distribution and organisation within skin lesions. Conclusion D-...

Validation of Dynamic optical coherence tomography for non-invasive, in vivo microcirculation imaging of the skin

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Objectives Dynamic optical coherence tomography (D-OCT) is anangiographic variation of OCT that non-invasively provides images of the in vivo microvasculature of the skin by combining conventional OCT images with flow data. The objective of this study was to investigate and report on the D-OCT technique for imaging of the vascular networks in skin as well as to validate the method by comparing the results against already accepted blood flow measuring tools. Methods 35 healthy subjects were recruited for the multicentre study, consisting of three experiments set up to examine the vascular blood perfusion during different induced physiologic changes in the blood flow. In order to validate the D-OCT images against existing techniques for blood flow measuring we performed consecutive D-OCT, chromametry and laser speckle contrast imager (LSCI) measurements on identical skin sites in all of the experiments. Blinded observer evaluations were performed in order to evaluate the vascular morp...

Dynamic Optical Coherence Tomography in Dermatology

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Optical coherence tomography (OCT) represents a non-invasive imaging technology, which may be applied to the diagnosis of non-melanoma skin cancer and which has recently been shown to improve the diagnostic accuracy of basal cell carcinoma. Technical developments of OCT continue to expand the applicability of OCT for different neoplastic and inflammatory skin diseases. Of these, dynamic OCT (D-OCT) based on speckle variance OCT is of special interest as it allows the in vivo evaluation of blood vessels and their distribution within specific lesions, providing additional functional information and consequently greater density of data. In an effort to assess the potential of D-OCT for future scientific and clinical studies, we have therefore reviewed the literature and preliminary unpublished data on the visualization of the microvasculature using D-OCT. Information on D-OCT in skin cancers including melanoma, as well as in a variety of other skin diseases, is presented in an atlas. P...

In vivo, micro-morphological vascular changes induced by topical brimonidine studied by Dynamic optical coherence tomography

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Background Brimonidine is a selective α2 adrenergic receptor agonist with potent vasoconstrictive activity topically used for treatment of facial flushing and erythema caused by rosacea. Direct evidence for the in vivo morphology changes in skin vessels induced by topical application of brimonidine is limited. Dynamic optical coherence tomography is a novel technology that combines conventional OCT with information on flow and thereby provides supplementary information about the microvasculature. Dynamic OCT is non-invasive and creates high-resolution in vivo images of skin to a depth of maximum 2 mm. Objective The objective of this study was to examine and describe micro-morphological skin vessel changes in normal skin exposed to brimonidine gel using Dynamic OCT. Materials and methods A total of 35 healthy subjects from three European clinical dermatology centres were included in the study. A normal skin area on the cheek was marked and clinically photographed. Brimonidine g...

Optical coherence tomography of actinic keratoses and basal cell carcinomas – differentiation by quantification of signal intensity and layer thickness

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Background Previous studies have shown that actinic keratoses (AKs) and basal cell carcinomas (BCCs) can be diagnosed by optical coherence tomography (OCT) based on morphological characteristics. There is a lack of systematic studies that give standardized information on signal intensity and layer thickness of AKs and BCCs. Objective The aim of this study was to find out if AKs and BCCs can be objectively diagnosed through standardized measurement of signal intensity and layer thickness and to use OCT as a non-invasive objective method for the diagnosis and evaluation of AKs and BCCs. Additionally, tumour and skin layer thickness were investigated in correlation with histology. Methods In this experimental study, 301 lesions (188 BCCs and 113 AKs) of 125 patients were clinically as well as dermoscopically diagnosed and investigated with OCT before therapy. Normal perilesional skin served as control. Results It is possible to differentiate BCCs and AKs from normal skin in OCT due to ...

Comparison of different optical coherence tomography devices for diagnosis of non-melanoma skin cancer

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Purpose To compare the diagnostic imaging ability of three different optical coherence tomography (OCT) devices in non-melanoma skin cancer (NMSC). Methods Thirty actinic keratoses (AKs) and 27 basal cell carcinomas (BCCs) of 29 patients were examined with three different OCT devices, VivoSight ® , Callisto ® and Skintell ® . Results Complete data sets were available for 16 BCCs and 10 AKs of 18 patients. All OCT devices were able to discriminate BCCs and AKs significantly from perilesional normal skin due to lower signal intensities as well as a thicker stratum corneum and epidermis in AKs. A significant decrease in the signal intensity and thickness of all skin layers was noted with Skintell ® in contrast to VivoSight ® and Callisto ® . OCT comparisons revealed only slight differences between VivoSight ® and Callisto ® . Regarding BCC tumor thickness VivoSight ® and Callisto ® correlated well, histology did not correlate with the three OCT d...

The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of nonpigmented basal cell carcinoma: an observational study – Ulrich – 2015 – British Journal of Dermatology – Wiley Online Library

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Background The diagnostic criteria for basal cell carcinoma (BCC) using optical coherence tomography (OCT) have been described previously, but the clinical value of these findings remains unknown. Objectives To investigate the diagnostic value of OCT for BCC in a typical clinical setting. The primary efficacy end point was a diagnosis of BCC for each lesion. Secondary end points were the diagnosis of other possible conditions. Methods This was an observational, prospective, multicentre study in which consecutive patients with nonpigmented pink lesions suspicious for BCC underwent clinical assessment, dermoscopy and OCT, with the diagnosis recorded at each stage. Once all diagnoses had been recorded, the histological results were disclosed. In total 164 patients with 256 lesions were recruited. Histology was missing for 21 lesions, leaving 235 lesions in 155 patients for analysis. Results Sixty per cent of lesions (141 of 235) were identified as BCC by histology. A slight increase of...

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