Two-photon fluorescence microscopy can be a diagnostic alternative for nonmelanoma skin cancers: JAMA

A new study conducted by Vincent D. Ching-Roa and team it was shown that the fact that two-photon fluorescence microscopy (TPFM) is capable of capturing the histological traits of nonmelanoma skin cancers (NMSCs) that are evident in traditional histology shows that it has the potential to serve as a quick, point-of-care diagnostic substitute without the requirement for laborious sample preparation or retraining for image interpretation. The findings of this study were published in the Journal of American Medical Association.

The primary method for diagnosing nonmelanoma skin malignancies is paraffin section histologic examination of skin biopsy samples, which might take days or weeks before a definitive conclusion is reached. Point-of-care diagnosis of NMSC and other dermatologic disorders may be possible with two-photon fluorescence microscopy, allowing for same-visit diagnosis and therapy. Therefore, this study was done to show that TPFM imaging of NMSC may happen shortly after getting biopsies, that it can offer similar histological characteristics to those of conventional histology, and to assess the performance of TPFM diagnostics in comparison to conventional histology.

29 recently removed biopsies from individuals who were seeking therapy for verified NMSC lesions were studied in this comparative efficacy pilot research. Between October 2019 and August 2021, biopsies were promptly imaged with TPFM on site at Rochester Dermatologic Surgery (Victor, New York). The co-registered pictures were created after the imaged biopsies were sent for paraffin histology. The training set consisted of 12 of these co-registered picture pairings (41.4%). In a masked assessment by a board-certified dermatopathologist, fifteen (51.7%) were used. Before assessment, two (6.1%) participants were removed from the trial because they were unable to co-register. Comparing TPFM for NMSC samples to traditional histology, the main results were sensitivity, specificity, and accuracy.

The key findings of this study were:

1. In the assessment set, TPFM and paraffin histology were both similarly classified in 14 out of 15 biopsy specimens (93.3%).

2. For the diagnosis of basal cell carcinoma, the TPFM exhibited 100% sensitivity, 100% specificity, and 100% accuracy.

3. TPFM showed a diagnostic accuracy of 93%, 100% specificity, and 89% for squamous cell carcinoma.

4. TPFM demonstrated a 93% sensitivity, 100% specificity, and 93% accuracy for total NMSC diagnosis.

5. The 1 discordant pair was examined, and it was discovered that the source of the problem was mismatched image planes.

In conclusion, the findings of this study point to the potential of TPFM imaging as a quick, point-of-care diagnostic tool that doesn't need extensive sample preparation or retraining for image evaluation, but additional validation of TPFM imaging in a larger cohort is required to fully evaluate diagnostic accuracy.

Reference:

Ching-Roa, V. D., Huang, C. Z., Ibrahim, S. F., Smoller, B. R., & Giacomelli, M. G. (2022). Real-time Analysis of Skin Biopsy Specimens With 2-Photon Fluorescence Microscopy. In JAMA Dermatology (Vol. 158, Issue 10, p. 1175). American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2022.3628