title: Evaluation of Optical Coherence Tomography as a Means of Identifying Earlier Stage Basal Cell Carcinomas while Reducing the Use of Diagnostic Biopsy.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of optical coherence tomography for basal cell carcinoma and the proportion of biopsies that could be avoided if optical coherence tomography is used to rule-in surgery.
  
  
  METHODS
  Multicenter, prospective, observational study.
  
  
  METHODS
  Dermatology clinics.
  
  
  METHODS
  Consecutive patients with clinically challenging pink lesions suspicious for basal cell carcinoma.
  
  
  METHODS
  Clinical, dermoscopic, and optical coherence tomography images were obtained for all subjects. At each stage, the clinician made a diagnosis (pathology + subtype if applicable), and assessed his/her own confidence in the diagnosis.
  
  
  RESULTS
  Optical coherence tomography significantly (p<0.01) improved sensitivity and specificity over clinical or dermoscopic evaluation. The percentage of correct diagnoses was 57.4 percent (clinical), 69.6 percent (dermoscopy), and 87.8 percent (optical coherence tomography). Optical coherence tomography significantly increased the certainty of diagnosis; clinicians indicated they were certain (>95% confident) in 17 percent of lesions examined clinically, in 38.6 percent examined with dermoscopy, and in 70 percent examined with optical coherence tomography. With the use of optical coherence tomography in the diagnosis of basal cell carcinoma, more than 1 in 3 patients could avoid a diagnostic biopsy.
  
  
  CONCLUSIONS
  In a population of clinically challenging lesions, optical coherence tomography improved diagnostic certainty by a factor of four over clinical examination alone and improved diagnostic accuracy by 50 percent (57-88%). The addition of optical coherence tomography to other standard assessments can improve the false-positive rate and give a high degree of certainty for ruling in a positive diagnosis for basal cell carcinoma. A reduction of 36 percent in overall biopsies could be achieved by sending high certainty basal cell carcinoma positive optical coherence tomography diagnoses straight to surgery.
authors.affiliation: Mount Sinai Medical Center, New York, New York; ; New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Orit
authors.initials: O
authors.lastname: Markowitz
authors.affiliation: Mount Sinai Medical Center, New York, New York; ; New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Michelle
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: Mount Sinai Medical Center, New York, New York; ; New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Eleanor
authors.initials: E
authors.lastname: Feldman
authors.affiliation: Mount Sinai Medical Center, New York, New York; ; New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Amanda
authors.initials: A
authors.lastname: Bienenfeld
authors.affiliation: Mount Sinai Medical Center, New York, New York; ; New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Amy K
authors.initials: AK
authors.lastname: Bieber
authors.affiliation: Downstate Medical Center, Brooklyn, New York; ; Belaray Dermatology, Hicksville, New York.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Ellis
authors.affiliation: New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Usha
authors.initials: U
authors.lastname: Alapati
authors.affiliation: Mount Sinai Medical Center, New York, New York;
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
authors.affiliation: New York Harbor Healthcare System, Brooklyn Campus, Brooklyn New York; ; Downstate Medical Center, Brooklyn, New York;
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Siegel