Two-photon fluorescence microscopy (TPFM) has high sensitivity, specificity, and accuracy for diagnosing nonmelanoma skin cancer (NMSC), according to a study published online Sept. 7 in JAMA Dermatology .

Vincent D. Ching-Roa, from the University of Rochester in New York, and colleagues conducted a comparative effectiveness pilot study examining 29 freshly excised biopsies from confirmed NMSC lesions in patients presenting for treatment. Biopsies were imaged immediately using TPFM and were subsequently submitted for paraffin histology to produce coregistered images. Twelve (41.4 percent) of these coregistered image pairs comprised the training set, and 15 (51.7 percent) were used in masked evaluation by a dermatopathologist; two were excluded because they could not be coregistered.

The researchers found that diagnosis was identical for 14 of 15 biopsy specimens (93.3 percent) using TPFM and paraffin histology. For basal cell carcinoma diagnosis, the TPFM had 100 percent sensitivity, 100 percent specificity, and 100 percent accuracy. For squamous cell carcinoma diagnosis, sensitivity, specificity, and accuracy were 89, 100, and 93 percent, respectively. For overall NMSC, TPFM had 93, 100, and 93 percent sensitivity, specificity, and accuracy, respectively. Mismatched imaging planes were identified as the source of error on examination of the discordant pair.

"While these results suggest potential as a rapid, point-of-care diagnostic tool that requires no extensive sample preparation or retraining for image evaluation, further validation of TPFM imaging in a larger cohort is necessary to fully evaluate diagnostic accuracy," the authors write.

One author reported a patent issued for aspects of histology with two-photon microscopy outside the submitted work.

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