In vivo confocal microscopy in clinical practice: comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader.

Rao BK, Mateus R, Wassef C, Pellacani G., J Am Acad Dermatol. 2013 Dec;69(6):e295-300. doi: 10.1016/j.jaad.2013.07.022.


BACKGROUND: Reflectance confocal microscopy (RCM) is an imaging tool that allows the visualization of cellular details without biopsy. To our knowledge, RCM sensitivity and specificity has not been studied in a telemedicine setting.


OBJECTIVE: We sought to assess RCM diagnostic accuracy in a support teleconsultation setting.

METHODS: Between June 2010 and September 2011, 340 lesions were imaged using a confocal scanning microscope. The images were evaluated by 2 readers, one on site, and the other at a distance.


RESULTS: A total of 334 cases were included. For each reader the sensitivity was greater than 90% and specificity for each reader was greater than 60%. Both readers had a combined sensitivity of 98.6% and 44% specificity.


LIMITATIONS: RCM may be limited in the correct classification of epithelial tumors.


CONCLUSIONS: RCM is a tool in the clinical diagnosis of skin lesions, providing a high diagnostic accuracy in teleconsultation use.