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Saknite I, Gill M, Alessi-Fox C, Zwerner JP, Lehman JS, Shinohara MM, Novoa RA, Chen H, Byrne M, Gonzalez S, Ardigo M, Tkaczyk ER. In Vivo Reflectance Confocal Microscopy of Cutaneous Acute Graft-Versus-Host Disease: Concordance with Histopathology and Interobserver Reproducibility of a Glossary with Representative Images. J Eur Acad Dermatol Venereol 2022; 36:1034-1044. [PMID: 35175678 DOI: 10.1111/jdv.18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The reliability to noninvasively identify features of inflammatory dermatoses by reflectance confocal microscopy (RCM) remains unknown. Lack of formal training among RCM readers can result in inconsistent assessments, limiting clinical utility. Specific consensus terminology with representative images is necessary to ensure consistent feature-level interpretation among RCM readers. OBJECTIVES (1) Develop a glossary with representative images of RCM features of cutaneous acute graft-versus-host disease (aGVHD) for consistent interpretation among observers, (2) assess the interobserver reproducibility among RCM readers using the glossary, and (3) determine the concordance between RCM and histopathology for aGVHD features. METHODS Through an iterative process of refinement and discussion among five international RCM experts, we developed a glossary with representative images of RCM features of aGVHD. From April to November 2018, patients suspected of aGVHD were imaged with RCM and subsequently biopsied. 17 lesions from 12 patients had clinically and pathologically confirmed cutaneous aGVHD. For each of these lesions, four dermatopathologists and four RCM readers independently evaluated the presence of aGVHD features in scanned histopathology slides and 1.5x1.5 mm RCM submosaics at 4 depths (blockstacks), respectively. RCM cases were adjudicated by a fifth RCM expert. Interobserver reproducibility was calculated by U statistic. Concordance between modalities was determined by fraction agreement. RESULTS We present a glossary with representative images of 18 aGVHD features by RCM. The average interobserver reproducibility among RCM readers (75%, confidence interval, CI: 71%-79%) did not differ significantly from dermatopathologists (80%, 76%-85%). The concordance between RCM and histopathology was 59%. CONCLUSIONS By using the glossary, the interobserver reproducibility among RCM readers was similar to the interobserver reproducibility among dermatopathologists. There was good concordance between RCM and histopathology to visualize aGVHD features. The implementation of RCM can now be advanced in a variety of inflammatory conditions with a validated glossary and representative image set.
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Affiliation(s)
- I Saknite
- Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN, 37204, USA.,Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgava Str 3 - #605, Riga, LV1004, Latvia
| | - M Gill
- SkinMedical Research and Diagnostics, PLLC, 64 Southlawn Ave, Dobbs Ferry, NY, 10522, USA.,Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.,Medicine and Medical Specialties Department, Alcalá University, 28871, Alcalá de Henares, Madrid, Spain
| | - C Alessi-Fox
- Clinical Development, Caliber Imaging and Diagnostics Inc, 50 Methodist Hill Drive, Suite 1000, Rochester, NY, 14623, USA
| | - J P Zwerner
- Department of Dermatology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - J S Lehman
- Division of Dermatology, Department of Medicine, Department of Laboratory Medicine and Pathology, University of Washington, Box 356524, Seattle, WA, 98195, USA
| | - M M Shinohara
- Department of Dermatology, Department of Pathology, Stanford University, 300 Pasteur Dr Rm H1507, MC 5627, Stanford, CA, 94305, USA
| | - R A Novoa
- Department of Biostatistics, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3903, Nashville, TN, 37232, USA
| | - H Chen
- Department of Biostatistics, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3903, Nashville, TN, 37232, USA.,Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - M Byrne
- Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - S Gonzalez
- Medicine and Medical Specialties Department, Alcalá University, 28871, Alcalá de Henares, Madrid, Spain
| | - M Ardigo
- San Gallicano Dermatological Institute - IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - E R Tkaczyk
- Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN, 37204, USA.,Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA.,Dermatology Service and Research Service, Tennessee Valley Healthcare System, Department of Veterans Affairs, 1310 24th Avenue South, Nashville, TN, 37212, USA
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Saknite I, Gill M, Alessi-Fox C, Byrne M, Jagasia M, Gonzalez S, Ardigo M, Tkaczyk ER. Features of cutaneous acute graft-versus-host disease by reflectance confocal microscopy. Br J Dermatol 2019; 181:829-831. [PMID: 30927259 DOI: 10.1111/bjd.17921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- I Saknite
- Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - M Gill
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A
| | | | - M Byrne
- Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - M Jagasia
- Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | | | | | - E R Tkaczyk
- Vanderbilt University Medical Center, Nashville, TN, U.S.A.,Dermatology Service and Research Service, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, U.S.A
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