title: In vivo confocal microscopy in clinical practice: comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey.
authors.forename: Babar K
authors.initials: BK
authors.lastname: Rao
authors.forename: Rosa
authors.initials: R
authors.lastname: Mateus
authors.forename: Cindy
authors.initials: C
authors.lastname: Wassef
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
mesh_terms: D002983:Clinical Competence; D003880:Dermatology; D006801:Humans; D018613:Microscopy, Confocal / Q000379:methods / Q000592:standards; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000473:pathology*; D019113:Telepathology
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