ABSTRACT
Noninvasive diagnostic strategies such as optical coherence tomography (OCT) enable detailed examination of skin tissue architecture and have potential for identification and subtyping of basal cell carcinoma (BCC). To evaluate the additional diagnostic value of OCT, a prospective cohort study was performed in 182 patients with 250 lesions suspected for non-melanoma skin premalignancies requiring a biopsy. Accuracy of BCC diagnosis and subtype on the basis of clinical examination (CE) of patients was compared with that on the basis of OCT scans in conjunction with clinical images of lesions (cOCT). Confidence levels were recorded on a 5-point scale, where score 0 indicated absence of BCC and scores 1-4 indicated increasing suspicion of BCC. Diagnostic performance parameters were compared using histopathologic diagnosis as gold standard. The patient-based area under the receiver operating characteristic curve (AUC) increased from 85.6% for CE to 91.2% for cOCT (P = 0.061) and the lesion-based AUC from 82.7% to 91.3% (P < 0.001). When confidence scores 1-4 were defined as positive, patient-based specificity increased from 47.5% (CE alone) to 76.8% (cOCT) at similar sensitivity (97.6% and 95.2%, respectively). cOCT slightly improved the ability to discriminate between superficial and nonsuperficial BCC subtypes and seemed to be a valuable addition to CE alone in the diagnosis and subtyping of BCC.
Subject(s)
Carcinoma, Basal Cell/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Tomography, Optical Coherence/methods , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificitySubject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Ipilimumab/adverse effects , Lymphocytosis/cerebrospinal fluid , Lymphocytosis/chemically induced , Neurotoxicity Syndromes/diagnosis , Nivolumab/adverse effects , Adult , Aged , Antibodies, Monoclonal, Humanized/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cell Cycle Checkpoints/drug effects , Cell Cycle Checkpoints/immunology , Female , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Ipilimumab/administration & dosage , Lymphocytosis/diagnosis , Male , Middle Aged , Neoplasms/cerebrospinal fluid , Neoplasms/drug therapy , Neoplasms/pathology , Nervous System Diseases/cerebrospinal fluid , Nervous System Diseases/chemically induced , Nervous System Diseases/diagnosis , Neurotoxicity Syndromes/cerebrospinal fluid , Neurotoxicity Syndromes/etiology , Nivolumab/administration & dosage , Protein Kinase Inhibitors/adverse effects , Protein Kinase Inhibitors/therapeutic use , Retrospective Studies , Severity of Illness IndexABSTRACT
In locally advanced non-small cell lung cancer (NSCLC) patients, consolidation therapy with durvalumab (an anti-PD-L1 monoclonal antibody) has proven to significantly increase both progression free and overall survival after chemoradiotherapy. Here, we describe a case of acute pneumonitis during durvalumab administration for locally advanced NSCLC, causing persistent symptomatology and steroid treatment to date. To our knowledge, acute-onset pneumonitis during infusion of a PD-L1 inhibitor has not been described previously. This case illustrates that ICI-induced pneumonitis can occur anytime during treatment, especially after chemoradiation.
