OCT non-inferior to biopsy in basal cell carcinoma

Optical coherence tomography (OCT) could offer a non-invasive alternative to biopsy for diagnosing and treating patients with basal cell carcinoma (BCC). A randomised trial showed that OCT was non-inferior to punch biopsy.

“BCC is a common type of skin cancer and punch biopsy is the gold standard for diagnosing this malignancy,” said Dr Tom Wolswijk (Maastricht UMC, the Netherlands) [1]. “Pain, infection, bleeding risk, and the 1–2 week waiting period until the results are available are, however, disadvantages of this method.” Thus, a team of researchers aimed to investigate whether OCT is non-inferior to punch biopsy for diagnosing and treating patients with suspected BCC. The researchers randomised 598 participants 1:1 to OCT or biopsy. If the diagnostic results of OCT were unclear, the patient was further treated based on biopsy results. The primary outcome was the proportion of patients with relapse-free survival (RFS) after 12 months of treatment. The results were recently published in the Lancet Oncology [2].

The modified intention-to-treat analysis showed that OCT was non-inferior to biopsy in terms of the proportion of patients who displayed RFS after 12 months of therapy (94% vs 93%; 95% CI -5.06 to 2.93). The results of the per-protocol analysis were comparable, with RFS rates of 95% and 94% for the respective study arms. Furthermore, for patients who had a clear OCT diagnosis, the sensitivity and specificity were 85.3% and 94.6%, respectively. Dr Wolswijk added that, in this study population with a BCC prevalence of 75%, a biopsy could be omitted in 66% of the patients. Finally, the study showed that OCT-based diagnostics and treatment were less costly than biopsy-based diagnostics and treatment (€ 689 vs € 758). However, purchasing an OCT instrument is an expensive matter.

Building on the results of this study, the research team is currently working on the refinement of OCT-driven diagnostics and treatment for patients with BCC by enhancing this technology with artificial intelligence.

 

1. Wolswijk T. What’s new NVED 2: Optical coherence tomography in de diagnostiek van basaalcelcarcinoom. Blok 6 Afsluitend Blok, DDD 2023, 9–10 March, Ermelo, the Netherlands.
2. Adan F, et al. Lancet Oncology. 2022;23(8):1087–1096.

Posted on 10 May, 2023