FDA and EMA-approved noninvasive imaging techniques for basal cell carcinoma subtyping: A systematic review
Mehdi Boostani, Giovanni Pellacani, Ximena Wortsman, Mariano Suppa, Mohamad Goldust, Carmen Cantisani, Paweł Pietkiewicz, Kende Lőrincz, András Bánvölgyi, Norbert Wikonkál, Wendy J. Huss, Kamran Avanaki, György Paragh, Norbert Kiss
Abstract
Background: Basal cell carcinoma (BCC), the most common skin cancer, requires accurate subtyping for optimal treatment. While histopathology is the gold standard, noninvasive imaging offers a biopsy-free alternative, though its accuracy remains unclear. Objective: To assess the diagnostic accuracy of Food and Drug Administration- and European Medicines Agency-approved noninvasive imaging techniques for BCC subtyping. Methods: A systematic review included 19 studies (2650 lesions) from EMBASE, Scopus, PubMed, and Cochrane Library (published up to November 30, 2024). Evaluated modalities included dermoscopy, high-frequency ultrasound (HFUS), dermoscopy-guided HFUS (DG-HFUS), optical coherence tomography (OCT), high-definition OCT (HD-OCT), dynamic OCT (D-OCT), line-field confocal OCT (LC-OCT), and reflectance confocal microscopy. Results: = .016). HD-OCT had 100% sensitivity for sBCC but lower accuracy for other subtypes. Reflectance confocal microscopy had 88.9% sensitivity for non-sBCC but only 33.3% for aggressive subtypes. Limitations: Study heterogeneity and inconsistent protocols limit comparability. Conclusion: LC-OCT and HD-OCT offer the highest accuracy, while DG-HFUS outperforms dermoscopy and HFUS, making them strong noninvasive alternatives.