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Extended report
Virtual skin biopsy by optical coherence tomography: the first quantitative imaging biomarker for scleroderma
  1. Giuseppina Abignano1,2,3,
  2. Sibel Zehra Aydin4,
  3. Concepción Castillo-Gallego5,
  4. Vasiliki Liakouli1,2,6,
  5. Daniel Woods7,
  6. Adam Meekings7,
  7. Richard J Wakefield1,2,
  8. Dennis G McGonagle1,2,
  9. Paul Emery1,2,
  10. Francesco Del Galdo1,2
  1. 1Division of Rheumatic and Musculoskeletal Diseases, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  2. 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Department of Clinical and Experimental Medicine, Rheumatology Section, Second University of Naples, Naples, Italy
  4. 4Department of Rheumatology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
  5. 5Unit of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
  6. 6Rheumatology Unit, Clinical Science and Biotechnology Department, University of L'Aquila, Italy
  7. 7Unit of Rheumatology, Michelson Diagnostics Ltd, Kent, UK
  1. Correspondence to Dr Francesco Del Galdo, Division of Rheumatic and Musculoskeletal Diseases, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds ls9 7pf, UK; f.delgaldo{at}leeds.ac.uk

Abstract

Background Skin involvement is of major prognostic value in systemic sclerosis (SSc) and often the primary outcome in clinical trials. Nevertheless, an objective, validated biomarker of skin fibrosis is lacking. Optical coherence tomography (OCT) is an imaging technology providing high-contrast images with 4 μm resolution, comparable with microscopy (‘virtual biopsy’). The present study evaluated OCT to detect and quantify skin fibrosis in SSc.

Methods We performed 458 OCT scans of hands and forearms on 21 SSc patients and 22 healthy controls. We compared the findings with histology from three skin biopsies and by correlation with clinical assessment of the skin. We calculated the optical density (OD) of the OCT images employing Matlab software and performed statistical analysis of the results, including intraobserver/interobserver reliability, employing SPSS software.

Results Comparison of OCT images with skin histology indicated a progressive loss of visualisation of the dermal–epidermal junction associated with dermal fibrosis. Furthermore, SSc affected skin showed a consistent decrease of OD in the papillary dermis, progressively worse in patients with worse modified Rodnan skin score (p<0.0001). Additionally, clinically unaffected skin was also distinguishable from healthy skin for its specific pattern of OD decrease in the reticular dermis (p<0.001). The technique showed an excellent intraobserver and interobserver reliability (intraclass correlation coefficient >0.8).

Conclusions OCT of the skin could offer a feasible and reliable quantitative outcome measure in SSc. Studies determining OCT sensitivity to change over time and its role in defining skin vasculopathy may pave the way to defining OCT as a valuable imaging biomarker in SSc.

  • Systemic Sclerosis
  • Outcomes research
  • Autoimmune Diseases

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