While ex vivo confocal laser scanning microscopy has previously demonstrated its utility in most common skin diseases, its use in the assessment of dermatological entities with lower incidence remains unexplored in most cases. We therefore aimed to evaluate the diagnostic efficacy of some rare skin tumors as well as a few inflammatory skin diseases, that have not yet been studied in ex vivo confocal laser scanning microscopy. A total of 50 tissue samples comprising 10 healthy controls, 10 basal cell carcinoma, 10 squamous cell carcinoma, and 20 rare skin conditions were imaged using the newest generation ex vivo confocal microscopy (Vivascope 2500 M-G4, Vivascope GmbH, Munich, Germany). Three blinded investigators were asked to identify characteristic features of rare skin disorders and distinguish them from more common skin diseases in the ex vivo confocal microscopy images. Our findings present the capability of ex vivo confocal microscopy to display distinctive morphologic patterns in common and rare skin diseases. As might be expected, we found a strong correlation between imaging experience and diagnostic accuracy. While the imaging inexperienced dermatohistopathologist reached 60% concordance, the imaging-trained dermatologist obtained 88% agreement with dermatohistopathology. The imaging-trained dermatohistopathologist achieved concordance up to 92% with gold-standard dermatohistopathology. This study highlights the potential of ex vivo confocal laser scanning microscopy as a promising adjunct to conventional dermatohistopathology for the early and precise identification of rare dermatological disorders.
尽管离体共聚焦激光扫描显微镜技术已在多数常见皮肤疾病中证实其应用价值，但其在低发病率皮肤疾病评估中的应用在多数情况下尚未得到探索。因此，本研究旨在评估该技术在若干尚未经离体共聚焦激光扫描显微镜研究的罕见皮肤肿瘤及炎症性皮肤病中的诊断效能。我们采用最新一代离体共聚焦显微镜（Vivascope 2500 M-G4，德国慕尼黑Vivascope公司）对50例组织样本进行成像分析，包括10例健康对照、10例基底细胞癌、10例鳞状细胞癌及20例罕见皮肤病变。三位盲态评估者通过离体共聚焦显微镜图像识别罕见皮肤病的特征性表现，并将其与常见皮肤病进行鉴别。研究结果显示，离体共聚焦显微镜能够清晰呈现常见及罕见皮肤病特有的形态学模式。与预期一致，我们发现图像诊断经验与诊断准确性呈显著正相关：无成像经验的皮肤组织病理医师诊断符合率为60%，经过成像培训的皮肤科医师诊断符合率达88%，而经过成像培训的皮肤组织病理医师与金标准组织病理诊断的一致性最高可达92%。本研究证实，离体共聚焦激光扫描显微镜作为传统皮肤组织病理学的补充手段，在罕见皮肤疾病的早期精准识别方面具有重要潜力。
Ex Vivo Confocal Laser Scanning Microscopy in Rare Skin Diseases
肿瘤(癌症)患者之家