Consistency and distribution of reflectance confocal microscopy features for diagnosis of cutaneous T cell lymphoma

Abstract

Abstract. Reflectance confocal microscopy (RCM) represents a noninvasive imaging technique that has previously been used for characterization of mycosis fungoides (MF) in a pilot study. We aimed to test the applicability of RCM for diagnosis and differential diagnosis of MF in a clinical study. A total of 39 test sites of 15 patients with a biopsy-proven diagnosis of either MF, parapsoriasis, Sézary syndrome, or lymphomatoid papulosis were analyzed for presence and absence of RCM features of MF. Cochran and Chi 2 analysis were applied to test the concordance between investigators and the distribution of RCM features, respectively. For selected parameters, the Cochran analysis showed good concordance between investigators. Inter-observer reproducibility was highest for junctional atypical lymphocytes, architectural disarray, and spongiosis. Similarly, Chi 2 analysis demonstrated that selected features were present at particularly high frequency in individual skin diseases, with values ranging from 73% to 100% of all examined cases.

The value ofin vivoreflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review

“… ACD, allergic contact dermatitis; ARD, acute radiation dermatitis; BAC, benzalkonium chloride; BP, bullous pemphigoid; BV, blood vessels; CD, contact dermatitis; CD3, cluster of differentiation 3; CDLE, chronic discoid lupus erythematosus; CLSM, confocal laser scanning microscopy; DC, dendritic cells; DEJ, dermoepidermal junction; DLE, discoid lupus erythematosus; DP, dermal papillae; EcP, extracorporal photopheresis; HE, haematoxylin and eosin; ICD, irritant contact dermatitis; ICH, immunohistochemical; INV (I and II), blinded investigators I and II, as per Lange‐Asschenfeldt et al …”

“…The majority of the included studies were categorized as papulosquamous and eczematous diagnoses: psoriasis, pityriasis rubra pilaris, lichen planus and lichen nitidus, radiation dermatitis, allergic and contact dermatitis . Cutaneous T‐cell lymphoma (mycosis fungoides, parapsoriasis en petite plaque, lymphomatoid papulosis, Sézary syndrome) and bullous diseases (pemphigus foliaceus, pemphigus vulgaris, bullous pemphigoid, Hailey–Hailey, Darier–White) have been examined as well by RCM. Other imaged diseases were alopecia and autoimmune connective tissue diseases like lupus, and systemic and lichen sclerosis .…”

“…Six studies with moderate methodological quality (Tables and S5), described features for different cutaneous T‐cell lymphomas that can mimic eczematous and papulosquamous dermatoses. General features for mycosis fungoides (MF), Sézary syndrome (SEZ), parapsoriasis en plaque (PARA) and lymphoid papulosis (LYP) were spongiosis, blurred intercellular demarcations, epidermal disarray, epidermal, junctional and dermal atypical lymphocytes, hyporefractile DP, BV dilatation, dendritic cells (DC), vesicle‐like structures, fibrosis and elongation of keratinocyte nuclei (Tables and S4).…”

Cutaneous T-cell Lymphoma

“…Junctional bright roundish and large pleomorphic cells, epidermal disarray and spongiosis were most significantly histologically correlated using RCM, with an 84–90% specificity for MF versus parapsoriasis or normal skin, but not versus other CTCL such as SS or LyP. Other findings include the loss of edged papillae (basal cells around dermal papillae look hyporefractile) in erythematous patch stage MF, hyperreflective dermal papillae in hyperpigmented MF, and disrupted dermal papillae rings in tumor stage MF [34–36]. Limitations at this time include that thick plaques and tumors cannot be analyzed using usual histologic correlates due to the thickened epidermal architecture preventing RCM access to the dermoepidermal junction.…”

Confocal Laser Scanning Microscopy as a Tool for the Investigation of Skin Drug Delivery Systems and Diagnosis of Skin Disorders

“…Diagnostic CRM criterion for mycosis fungoids was first determined by Agero et al in 2007 [103] and later on confirmed by Lange-Asschenfeldt et al (2012) [104].…”