LC-OCT for early diagnosis and characterization of dermatologic adverse events to oncologic drugs and correlation to histopathology.

IF 3.5 4区 医学 Q1 DERMATOLOGY
Pietro Sollena, Marisa Salvi, Marica Marraffa, Luca Pellegrino, Simone Cappilli, Gerardo Palmisano, Maria Mannino, Lucia Di Nardo, Alessandro Di Stefani, Ketty Peris
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引用次数: 0

Abstract

Background: Targeted and immune therapies have recently been associated with the occurrence of multiple cutaneous toxicities, often challenging to differentiate by clinical examination alone without histology. Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive and innovative imaging technique that has been shown to be almost as effective as histology in diagnosing several skin conditions. Our study aimed to assess the effectiveness of LC-OCT in predicting the clinical evolution of early maculopapular eruptions related to antineoplastic targeted therapy and immunotherapy.

Methods: In the period between May 2023 and December 2023, consecutive patients with clinical cutaneous maculopapular reactions caused by oncologic targeted therapy or immunotherapy were enrolled at the dermatologic outpatient clinic of the Fondazione Policlinico A. Gemelli IRCCS, Rome. Patients underwent clinical dermatological examination, video-dermoscopy, LC-OCT, and incisional skin biopsy of a target cutaneous lesion. To investigate the evolutionary pattern of maculopapular lesions (psoriasic eruption, lichenoid eruption, eczematous eruption, bullous eruption), LC-OCT and histopathological images have been compared based on specific characteristics (hyperkeratosis, acanthosis, spongiosis; papillomatosis; lichenoid inflammatory infiltrate; presence of intraepidermal/subepidermal cleavage plan with formation of a bulla).

Results: Eighteen patients were included in this study (11 males, 7 females, median age 64.5). LC-OCT demonstrated an overall concordance with histology of 77.8%, with a Cohen's Kappa of 0.69 (P < 0.0001). Sensitivity exceeded 70%, and specificity was ≥88.2%. The Area Under the Curve (AUC) ranged from 0.9 to 1 for psoriasis and lichenoid eruption and from 0.7 to 0.9 for eczematous and bullous eruption.

Conclusions: LC-OCT appears to be a promising tool for the early differential diagnosis of adverse skin reactions related to targeted therapy and immunotherapy, offering the potential to avoid skin biopsies in fragile cancer patients.

LC-OCT 用于肿瘤药物皮肤不良反应的早期诊断和定性以及与组织病理学的相关性。
背景:靶向疗法和免疫疗法近来与多种皮肤毒性的发生有关,这些毒性通常很难在没有组织学检查的情况下仅通过临床检查加以区分。线场共聚焦光学相干断层扫描(LC-OCT)是一种非侵入性的创新成像技术,在诊断多种皮肤病方面几乎与组织学检查一样有效。我们的研究旨在评估 LC-OCT 在预测与抗肿瘤靶向治疗和免疫治疗相关的早期斑丘疹临床演变方面的有效性:在2023年5月至2023年12月期间,罗马Fondazione Policlinico A. Gemelli IRCCS皮肤科门诊连续收治了因肿瘤靶向治疗或免疫治疗引起临床皮肤斑丘疹反应的患者。患者接受了临床皮肤病检查、视频皮肤镜检查、LC-OCT检查和目标皮肤病变的切开皮肤活检。为了研究斑丘疹皮损的演变模式(银屑病性糜烂、苔藓样糜烂、湿疹性糜烂、牛皮癣性糜烂),我们根据具体特征(角化过度、棘层增生、海绵状增生;乳头状瘤病;苔藓样炎性浸润;表皮内/表皮下裂隙形成牛皮癣)对 LC-OCT 和组织病理学图像进行了比较:本研究共纳入 18 名患者(男性 11 人,女性 7 人,中位年龄 64.5 岁)。LC-OCT 与组织学的总体一致性为 77.8%,Cohen's Kappa 为 0.69(P 结论:LC-OCT 与组织学的总体一致性为 77.8%,Cohen's Kappa 为 0.69:LC-OCT 似乎是一种很有前途的工具,可用于早期鉴别诊断与靶向治疗和免疫疗法相关的皮肤不良反应,从而有可能避免对脆弱的癌症患者进行皮肤活检。
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来源期刊
CiteScore
4.70
自引率
2.80%
发文量
476
审稿时长
3 months
期刊介绍: Published monthly, the International Journal of Dermatology is specifically designed to provide dermatologists around the world with a regular, up-to-date source of information on all aspects of the diagnosis and management of skin diseases. Accepted articles regularly cover clinical trials; education; morphology; pharmacology and therapeutics; case reports, and reviews. Additional features include tropical medical reports, news, correspondence, proceedings and transactions, and education. The International Journal of Dermatology is guided by a distinguished, international editorial board and emphasizes a global approach to continuing medical education for physicians and other providers of health care with a specific interest in problems relating to the skin.
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