title: The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of nonpigmented basal cell carcinoma: an observational study.
abstract: 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.
  
  
  OBJECTIVE
  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 sensitivity was noted following OCT, which did not reach statistical significance. The specificity increased significantly from 28·6% by clinical assessment to 54·3% using dermoscopy and to 75·3% with the addition of OCT (P < 0·001). The positive predictive value for the diagnosis of BCC using OCT was 85·2% [95% confidence interval (CI) 78·6-90·4], and the negative predictive value was 92·1% (95% CI 83·6-97·0). The accuracy of diagnosis for all lesions increased from 65·8% with clinical evaluation to 76·2% following additional dermoscopy and to 87·4% with the addition of OCT.
  
  
  CONCLUSIONS
  OCT significantly improved the diagnostic specificity for BCC compared with clinical assessment and dermoscopy alone.
authors.affiliation: Private Dermatology Office/CMB Collegium Medicum Berlin GmbH, Luisenstraße 54/55, 10117, Berlin, Germany.|Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ulrich
authors.affiliation: Department of Dermatology and Allergology, University Hospital Munich, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: von Braunmuehl
authors.affiliation: Private Dermatology Office, Freising, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Kurzen
authors.affiliation: Private Dermatology Office Prof Thomas Dirschka, Wuppertal, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Dirschka
authors.affiliation: Dermatology Center Bonn Friedensplatz, Bonn, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kellner
authors.affiliation: Department of Dermatology and Allergology, University Hospital Munich, Munich, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Sattler
authors.affiliation: Department of Dermatology and Allergology, University Hospital Munich, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Berking
authors.affiliation: Department for Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Welzel
authors.affiliation: Dermatology Center Bonn Friedensplatz, Bonn, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Reinhold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D002280:Basal Cell Carcinoma / Q000175:diagnosis; D046169:Dermoscopy / Q000592:standards; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis; D041623:Tomography, Optical Coherence / Q000592:standards