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

Background: Reflectance 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. Objective: We sought to assess RCM diagnostic accuracy in a support teleconsultation setting. Methods: Between 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. Results: A 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. Limitations: RCM may be limited in the correct classification of epithelial tumors. Conclusions: RCM is a tool in the clinical diagnosis of skin lesions, providing a high diagnostic accuracy in teleconsultation use.