Line-Field Confocal Optical Coherence Tomography of Basal Cell Carcinoma: Systematic Correlation with Histopathology

Area of Science:

• Dermatology
• Medical Imaging
• Oncology

Background:

• Basal cell carcinoma (BCC) is the most common skin cancer in Caucasians.
• Histopathology is required for accurate BCC subtype classification, while dermoscopy aids diagnosis.
• Line-field confocal optical coherence tomography (LC-OCT) offers high-resolution 3D imaging, bridging the gap between dermoscopy and histopathology.

Purpose of the Study:

• To evaluate the concordance between LC-OCT and histopathology for basal cell carcinoma (BCC) diagnostic criteria and subtypes.
• To assess the utility of LC-OCT as a non-invasive tool for BCC evaluation.

Main Methods:

• Retrospective analysis of 127 histopathologically confirmed BCCs.
• Evaluation of LC-OCT images and corresponding histopathological slides.
• Objective analysis using a predefined checklist and subjective analysis via side-by-side assessments by three observers.

Main Results:

• High concordance (≥80%) between LC-OCT and histopathology for lobules, blood vessels, bright cells, lobule location, and dermal-epidermal junction disruption.
• Intermediate concordance (50-80%) for hemispheric morphology, outer bright rim, stromal stretching, and parakeratosis.
• Strong overall resemblance between LC-OCT and histopathology (81.1% concordance) in subjective evaluations.

Conclusions:

• LC-OCT demonstrates good concordance with histopathology for key BCC diagnostic and subtype-discriminating features.
• LC-OCT shows potential as a clinically relevant tool for non-invasive BCC diagnosis and management.
• Variability exists for subtle criteria, but overall findings support LC-OCT's clinical utility.