Objective: Ex vivo confocal laser scanning microscopy (EVCM) is an emerging imaging technique, which offers rapid tissue examination. While the current literature shows promising results in the evaluation of non-melanoma skin cancer, only limited research exists on the application of EVCM in melanocytic lesions. This study aimed to assess the utility of EVCM in the characterization of melanocytic lesions and compare its findings with gold-standard histopathology. Methods: A total of 130 skin lesions, including 76 benign and 54 malignant melanocytic lesions, were prospectively collected and imaged using EVCM. Three blinded investigators were asked to identify characteristic morphologic features observed in the lesions and classify them into benign vs. malignant. The results were then compared with the corresponding histopathology. Sensitivity and specificity were calculated using contingency tables to assess the diagnostic performance. Results: The application of EVCM allowed for the visualization of cellular and tissue-level details, including cellular pleomorphism and atypical melanocytes. A comprehensive list of benign and malignant features identified by EVCM was compiled. Using these diagnostic criteria, the imaging of the inexperienced and dermatohistopathology-experienced investigator reached 67.7% concordance, and the imaging trained dermatologist obtained 69.2% agreement with dermatohistopathology in differentiating benign vs. malignant lesions. The imaging-trained dermatohistopathologist performed best with concordance up to 79.2%. Conclusions: In conclusion, EVCM is a promising technique for the rapid assessment of melanocytic lesions. Our study provides a comprehensive overview of morphologic EVCM features, which will contribute to the development of diagnostic algorithms for accurate diagnosis and appropriate treatment planning. Further studies are needed to evaluate its clinical utility and validate our diagnostic criteria.
目的：离体共聚焦激光扫描显微镜（EVCM）是一种新兴的成像技术，可实现快速组织检查。现有文献显示其在非黑色素瘤皮肤癌评估中具有良好前景，但关于EVCM在黑色素细胞性皮损中应用的研究仍十分有限。本研究旨在评估EVCM在黑色素细胞性皮损特征识别中的应用价值，并将其结果与金标准组织病理学进行对比。方法：前瞻性收集130例皮肤皮损（包括76例良性和54例恶性黑色素细胞性皮损），采用EVCM进行成像。由三位盲态研究者识别皮损中观察到的特征性形态学表现，并将其分类为良性或恶性。结果与对应组织病理学诊断进行比较，通过列联表计算敏感性和特异性以评估诊断效能。结果：EVCM能够清晰呈现细胞及组织层面的细节特征，包括细胞多形性和非典型黑色素细胞。研究系统整理了EVCM识别的良恶性特征清单。基于这些诊断标准，无经验研究者与皮肤组织病理学专家的影像诊断一致性达67.7%，经过影像培训的皮肤科医生在区分良恶性皮损方面与皮肤组织病理学的一致性为69.2%。而经过影像培训的皮肤组织病理学家表现最佳，一致性高达79.2%。结论：EVCM是快速评估黑色素细胞性皮损的潜力技术。本研究系统总结了EVCM形态学特征，将为开发精准诊断和制定治疗方案的诊断算法提供重要依据。未来仍需进一步研究以评估其临床实用性并验证本研究的诊断标准。
肿瘤(癌症)患者之家