title: Accuracy of in vivo confocal microscopy for diagnosis of basal cell carcinoma: a comparative study between handheld and wide-probe confocal imaging.
abstract: BACKGROUND
  Reflectance confocal microscopy (RCM) increases specificity of identification of basal cell carcinoma (BCC). A smaller-diameter handheld RCM (HH-RCM) allows better access to limited anatomic locations.
  
  
  OBJECTIVE
  To compare accuracy of HH-RCM in identification of BCC to that of traditional wide-probe RCM (TWP-RCM).
  
  
  METHODS
  Patients presenting at least one lesion clinically and dermoscopically suspicious for BCC, were recruited from two dermatology skin cancer clinics. Prior to excision, we attempted to image all lesions with HH-RCM and TWP-RCM using a standardized protocol. RCM images were retrospectively evaluated, jointly by two blinded readers. For purposes of comparative RCM, sensitivity and specificity analysis, we used a threshold of ≥3 RCM criteria to identify BCC, whereby at least one criterion had to be presence of 'dark silhouettes' or 'bright tumor islands'.
  
  
  RESULTS
  Among 54 lesions imaged with both RCM devices, 45 were biopsy-proven BCCs. Comparison between TWP-RCM vs. HH-RCM was as follows: sensitivity (100% vs. 93%), specificity (78% for both probes), positive predictive value (96% vs. 95%), and negative predictive value (100% vs. 70%) respectively. Notably, both TWP-RCM and HH-RCM demonstrated the presence of 'dark silhouettes' or 'bright tumor islands' in all 45 BCCs.
  
  
  CONCLUSIONS
  Both RCM probes demonstrate high PPV. TWP-RCM shows higher NPV, since its broader field-of-view probably allows more exhaustive search for BCC criteria. The RCM criteria threshold for BCC identification should be further tested.
authors.affiliation: Department of Cutaneous Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors.forename: R P
authors.initials: RP
authors.lastname: Castro
authors.affiliation: Skin and Cancer Associations, Plantation, FL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Stephens
authors.affiliation: Skin and Cancer Associations, Plantation, FL, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Fraga-Braghiroli
authors.affiliation: Skin and Cancer Associations, Plantation, FL, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Oliviero
authors.affiliation: Department of Cutaneous Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
authors.forename: G G
authors.initials: GG
authors.lastname: Rezze
authors.affiliation: Skin and Cancer Associations, Plantation, FL, USA.
authors.forename: H
authors.initials: H
authors.lastname: Rabinovitz
authors.affiliation: Dermatology Department, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.|Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Scope
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology*; D005153:Facial Neoplasms / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007642:Keratosis / Q000473:pathology; D008297:Male; D018328:Melanoma, Amelanotic / Q000473:pathology*; D018613:Microscopy, Confocal / Q000295:instrumentation; D008875:Middle Aged; D011237:Predictive Value of Tests; D012878:Skin Neoplasms / Q000473:pathology*