TY - JOUR
T1 - An international 3-center training and reading study to assess basal cell carcinoma surgical margins with ex vivo fluorescence confocal microscopy
AU - Kose, Kivanc
AU - Fox, Christi Alessi
AU - Rossi, Anthony
AU - Jain, Manu
AU - Cordova, Miguel
AU - Dusza, Stephen W.
AU - Ragazzi, Moira
AU - Gardini, Stefano
AU - Moscarella, Elvira
AU - Diaz, Alba
AU - Pigem, Ramon
AU - Gonzalez, Salvador
AU - Bennassar, Antoni
AU - Carrera, Cristina
AU - Longo, Caterina
AU - Rajadhyaksha, Milind
AU - Nehal, Kishwer S.
N1 - Funding Information:
The research at MSKCC was supported by grants from the NIH (R01CA199673, R01CA201399, R01EB020029, R01EB002715, R01EB012466), the Byrne Fund at MSKCC, and, in part, by an NCI Cancer Center grant (P30 CA008748). The research at the Melanoma Unit in Barcelona is partially funded by Grants PI15/00716 and PI15/00956 from Fondo de Investigaciones Sanitarias, Spain; by the CIBER de Enfermedades Raras of the Instituto de Salud Carlos III, Spain; by the AGAUR 2014_SGR_603 of the Catalan Government, Spain; by the European Commission under the sixth Framework Programme, Contract nr: LSHC‐CT‐2006‐018702 (GenoMEL), under the seventh Framework Programme (Diagnoptics); by the MARATÓ de TV3 Foundation; by the Leo Messi Foundation. Anthony Rossi's research is funded by ASLMS: A Ward Memorial Research Grant, and Skin Cancer Foundation: Research Grant.
Funding Information:
American Society for Laser Medicine and Surgery; A Ward Memorial Research Grant, and Skin Cancer Fo; Byrne Fund at MSKCC; Catalan Government, Grant/Award Number: AGAUR 2014_SGR_603; Center for Scientific Review, Grant/Award Numbers: R01CA199673, R01CA201399, R01EB002715, R01EB012466, R01EB020029; Center for Strategic Scientific Initiatives, National Cancer Institute, Grant/Award Number: P30 CA008748; CIBER de Enfermedades Raras of the Instituto de Salud Carlos III; Fondo de Investigaciones Sanitarias, Grant/Award Numbers: PI15/00716, PI15/00956; Seventh Framework Program: Diagnoptics; Leo Messi Foundation; MARATÓ de TV3 Foundation; Sixth Framework Programme, Grant/Award Number: LSHC‐CT‐2006‐018702 (GenoMEL) Funding information
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2021/8
Y1 - 2021/8
N2 - Background: Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. Objective: To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. Methods: An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. Results: Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. Limitations: Small dataset, variability in mosaic quality between centers. Conclusion: Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
AB - Background: Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. Objective: To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. Methods: An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. Results: Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. Limitations: Small dataset, variability in mosaic quality between centers. Conclusion: Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
KW - basal cell carcinoma
KW - fluorescence confocal microscopy
KW - fresh tissue imaging
KW - rapid margin mapping
KW - surgical excision
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U2 - 10.1111/cup.13980
DO - 10.1111/cup.13980
M3 - Article
C2 - 33576022
AN - SCOPUS:85101908332
VL - 48
SP - 1010
EP - 1019
JO - Journal of Cutaneous Pathology
JF - Journal of Cutaneous Pathology
SN - 0303-6987
IS - 8
ER -