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The following is a summary of “Interobserver agreement on line-field confocal optical coherence tomography image markers in keratinocyte carcinomas and precursor lesions,” published in the September 2024 issue of Dermatology by Jacobsen et al.

Line-field confocal optical coherence tomography (LC-OCT), a novel technology for skin cancer diagnosis, has not yet been evaluated for interobserver agreement (IOA) of known image markers for keratinocyte carcinomas (KC), including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and precursors, SCC in situ (CIS) and actinic keratosis (AK).

Researchers conducted a retrospective study assessing inter-observer agreement on LC-OCT image markers for keratoconus and its precursors among novice evaluators with varying dermatological imaging experience and to analyze the relationship between reported image markers and lesion types.

They recruited 6 evaluators who were blinded to histopathologic diagnoses and assessed 75 LC-OCT images of KC (21 SCC; 21 BCC), CIS (12), and AK (21). Each evaluator independently reported the presence or absence of 10 predefined key image markers of KCs and precursors. Evaluators were divided into experienced (3) and novice (3) groups based on their prior OCT and confocal microscopy experience. The IOA was tested using Conger’s kappa coefficient (κ). The frequency of reported image markers and the link with lesion types were calculated as proportions and OR.

The results showed overall IOA was highest for the image markers lobules (κ = 0.68, 95% CI 0.57;0.78) and clefting (κ = 0.63, CI 0.52;0.74), typically seen in BCC (94%; OR 143.2 and 158.7, respectively, P<0.001), followed by severe dysplasia (κ = 0.42, CI 0.31;0.53), observed primarily in CIS (79%; OR 7.1, P<0.001). The remaining 7 image markers had lower IOA (κ = 0.06–0.32) and were more evenly observed across lesion types. The lowest IOA was noted for a well-defined (κ = 0.07, CI 0;0.15) and interrupted dermal-epidermal junction (DEJ) (κ = 0.06, CI -0.002;0.13). The IOA was higher for all image markers among experienced evaluators vs. novices.

They concluded that inter-observer agreement for key image markers of keratoconus and precursors in LC-OCT images varied among novice evaluators, with the highest deal observed for lobules, clefting, and severe dysplasia and the lowest for DEJ integrity assessment.

Source: link.springer.com/article/10.1007/s00403-024-03344-y