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

BackgroundReflectance 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.ObjectiveWe sought to assess RCM diagnostic accuracy in a support teleconsultation setting.MethodsBetween 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.ResultsA 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.LimitationsRCM may be limited in the correct classification of epithelial tumors.ConclusionsRCM is a tool in the clinical diagnosis of skin lesions, providing a high diagnostic accuracy in teleconsultation use.