In vivo confocal microscopy in clinical practice: Comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader

• Published in: Journal of the American Academy of Dermatology 2013-12, Vol.69 (6), p.e295-e300
• Main Authors: Rao, Babar K., MD, Mateus, Rosa, MD, Wassef, Cindy, BA, Pellacani, Giovanni, MD
• Format: Article
• Language: English
• Subjects: Clinical Competence; cutaneous lesions; Dermatology; Humans; Microscopy, Confocal - methods; Microscopy, Confocal - standards; noninvasive imaging; Point-of-Care Systems; reflectance confocal microscopy; Reproducibility of Results; Skin Diseases - pathology; teledermatology; Telepathology
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2013.07.022

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. Limitations 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.