In our inaugural year we were pleased to host two meetings - please see below for the topics that were presented.
DDG Berlin, 30th April 2015
Andy Hill CEO at Michelson Diagnostics: Welcome to OCT in Focus
Prof Julia Welzel: Speckle-variance OCT
Sandra Schuh: OCT of actinic keratosis and basal cell carcinomas – quantification of signal intensity and thickness of layers using different OCT devices.
Dr Mette Mogensen: OCT imaging of wound healing & OCT imaging of cutaneous T-cell lymphomas.
Dr Bernd Algermissen: Margin mapping with OCT—safer removal of BCC
Dr Martina Ulrich: Diagnostic accuracy of OCT for BCC diagnosis - results of a multicenter study
Prof Hjalmar Kurzen: OCT cases I learnt from
Dr Gerald Messer: The current standard diagnostic severity score of onychomycosis by optical coherence tomography (OCT)
EADV Copenhagen, 9th October 2015
We were delighted to see a completely packed room at the OCT in Focus meeting held during the EADV in Copenhagen. Thank you to those who took the time to attend. We hope you found the meeting useful and that you learnt something new from the presentations of the OCT studies currently in progress.
For those who were unable to make the meeting, please find summaries of each of the presentations, some including videos, below.
A PDF copy of the newsletter from this event can also be found here.
Lotte Themstrup: The added clinical benefit from OCT in BCC follow-up
Lotte Themstrup from Roskilde hospital presented a series of interesting cases from a study investigating the use of OCT for post PDT therapy on 58 BCC patients. In 6 of the cases, OCT detected BCC recurrence that were not clinically obvious. Two of these cases were presented with OCT scans nicely depicting the areas of BCC recurrence. Histology confirmed the BCC recurrence in all cases. Lotte concluded that the study suggests OCT can be used as a useful adjunct tool in the clinic for follow-up after PDT treatment of BCC. However, more studies would be required to determine the sensitivity and specificity values to further confirm these results.
Giovanni Pellacani: Dynamic OCT for assessment of skin tumours
Giovanni presented some interesting images with some fantastic 3D rendered images of BCCs, melanomas and nevi using Dynamic OCT with additional contouring feature. A series of cases for different staged BCCs were shown giving clear visibility of the vascularisation changes, small branching vessels to very large branching vessels. Vascularisation patterns for melanoma progression were also analysed and it was clear from the OCT images that the further the progression of the melanoma the larger the vessels. Comparing these patterns with BCC, there seemed to be more ‘spikes’ or ‘vessel columns’ which could be characteristic of melanoma. Nevi vascular patterns tended to be a smaller density of vessels formed of loops going up. Intradermal Nevi can be seen as very slow growing, BCC as a moderate growing tumour and melanoma as a rapidly growing tumour. Different patterns are observed depending on the velocity of growth.
Concluding, vascular architecture can be rapidly imaged in vivo using SV-OCT with 3D rendering giving more information on the vessel architecture. Vascular pattern is related to tumour burden and pattern of growth.
Daniel Thaysen-Petersen: OCT imaging of laser assisted drug delivery using tissue dye as contrast agent
Daniel presented an interesting study on the capabilities of OCT in the field of laser assisted drug delivery. The aim of the study was to investigate whether OCT can visualise filling of channels after fractional ablative laser (AFXL) procedures and further understand whether the filling process of AFXL differs between vehicle types. All the experiments were performed on excised porcine skin with the solution types being aqueous, crème and gel.
The results showed that OCT could visualise the filling process of AFXL channels. Not only this, but it was able to further confirm that gel may fill AFXL channels more sufficiently than creme and aquaous solution.
Mette Mogensen: Dynamic OCT capillaroscopy of Dermatomyositis
Mette Mogensen presented using Dynamic OCT to image the vascular patterns in the nail bed for a healthy voulnteer, a patient with systemic sclerosis and systemic lupus erythematosus (SLE), and a patient with dermatomyositis. In the healthy volunteer, dynamic OCT imaging visualised the regular distribution of hair pin shaped vessels in the nailfold and the deeper dermal vessels in the finger. In the patient with systemic sclerosis and SLE the abnormal dilated capillaries can be visualised. This was also the case in the patient with dermatomyositis. Concluding that dynamic OCT imaging of nail fold capillaries is a promising new diagnostic tool.
Sandra Schuh: Clinical, histological and optical coherence tomography comparison of actinic keratoses grading and signal intensities of basal cell carcinoma subtypes in optical coherence tomography
Sandra Schuh presented some cases from her study aimed at determining whether signal intensity measurements can enable differentiation of BCC subtypes and how a scoring system of actinic keratosis using OCT can be compared with those used in histology and clinical.
For the signal intensity study, the measurements were made at the same depth on a single OCT slice for scanned areas of both BCC lesion and corresponding healthy skin. After examination, lesions were biopsied and diagnoses confirmed by histology. The results suggested that superficial BCCs showed higher signal intensities when compared to sclerosing or nodular BCCs.
The developed AK grading score in OCT was compared to the clinical grading by the Olsen classification and to the histological grading by the Cockerell classification. Results showed that there was medium correlation between AK grading in clinical and OCT and minor correlation between clinical and histological AK classification.There seemed to be no correlation regarding AK grading between histology and OCT after all.
Martina Ulrich: OCT criteria for diagnosis of BCC and differentiation from other NMSC
Martina presented results from the publication titled ‘Assessment of a scoring system for Basal Cell Carcinoma with multi-beam optical coherence tomography’ performed at the Charité. The aim of this study was to attempt to produce a scoring system for diagnosis of BCC. 3 main criteria were set, these were: the dark boarder underneath the tumour, the hyporeflective regions and the ovoid structures. A high score suggested the diagnosis was BCC. Where the score was high the positive predictive and the specificity value were high but the sensitivity value was low. The criteria helped with the diagnosis of the BCC more than the scoring did, though the score did give you an impression of how confident your diagnosis was. The scoring however made the differentiation of NMSC difficult. Results also indicated the importance of training in OCT image interpretation.
Martina presented some results from the study titled ‘The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of non-pigmented basal cell carcinoma – an observational study’. This study was performed at six centers on 256 unclear pink patches. A clinical, dermoscopy and OCT diagnose was made at each stage. The positive predictive value and negative predictive value were greatest for OCT and overall the accuracy of diagnosis for BCC increased from 65.8% (clinical alone) to 87.4% with the addition of OCT. Concluding, OCT Is applicable for the primary diagnosis of non melanoma skin cancer and especially BCC and Improves the diagnotic accuracy of „pink patches“.
A final interesting case was shown of the visualisation of the vascularization in a BCC. Martina commented that though further studies are required (currently being performed by the ADVANCE project) SV-OCT may add additional information on tumour type and may help to identify tumour at higher risk for metastasis.
Nathalie De Carvalho: Basal cell carcinoma and melanoma vascularization by means of dynamic OCT:
Nathalie presented two projects she has been working on: one on using SV OCT (a.k.a dynamic OCT) to differentiate the vascularisation for different BCC subtypes and another on using SV OCT to map the margins of BCC.Cases depicting the vasculature in the SV OCT image were presented of superficial, palpable, elevated and nodular basal cell carcinomas. In the en-face view (horizontal slice of the SV OCT image) changes in the vascular patterns followed the progression of BCCs. The results concluded that as in clinical and dermsocopy we can also follow grading in vascular patterns in SV OCT.
A single case was also presented on the margination project. The aim of the study was to find out if SV OCT could be used to reduce the number of excisions required to remove a BCC. The method adopted a pen which appeared hyperreflective in the OCT image. The OCT imaging device was used to check to see if anything remaining of the lesion was left outside the clinical margin. If this was the case, the line would be extended until all of the lesion was inside the margins. After evaluating the borders of the lesion by means of SV OCT, the lesion was surgically excised and evaluated by conventional histology. These early results suggest that SV OCT could be used to assess the margins of BCCs and, consequently, reduce the number of re-excisions.
Julia Welzel: Inflammatory and degenerative skin diseases: Case reports of dynamic OCT
Julia Welzel presented some case reports on dynamic OCT of inflammatory and degenerative skin diseases as well as of treatment effects. She showed a case of scleroderma of the nailfold, a chronic leg ulcer, rosacea before and after dye laser therapy and a tattoo before and after Nd:YAG laser therapy.
In venous ulcers, the blood vessels were arranged in a glomerulum-like pattern. Not only the blood vessel network showed changes but also a prominent dilatation of lymphatic vessels without flow was visible. The laser treatments caused a rapid "swicth-off" of all visible larger vessels, whereas the smaller dotted vessels were still detectable.