Optical coherence tomography for diagnosing recurrent or residual basal cell carcinoma after topical treatment: A diagnostic cohort study.

BACKGROUND: Recurrent/residual basal cell carcinoma (BCC) after topical treatment may not be visible during clinical and dermatoscopic examination (CDE). Optical coherence tomography (OCT) may detect these subclinical recurrences or residues. OBJECTIVE: To compare the diagnostic accuracy of CDE with that of CDE combined with OCT (CDE-OCT) for detecting recurrent/residual BCC after topical treatment of superficial BCC. METHODS: In this diagnostic cohort study, the suspicion level for recurrence or residue was recorded on a 5-point confidence scale. All patients with high suspicion of recurrence or residue based on CDE and/or CDE-OCT were referred for punch biopsy. Patients with a low suspicion on CDE and CDE-OCT were asked to (voluntarily) undergo a control biopsy. Histopathologic results of the biopsy were used for verification of CDE and CDE-OCT diagnoses (gold standard). RESULTS: This study included 100 patients. A histopathologic recurrent/residual BCC was found in 20 patients. For recurrence or residue detection, sensitivity was 100% (20 of 20) for CDE-OCT and 60% (12 of 20) for CDE (P = .005) and specificity was 95% for CDE-OCT and 96.3% for CDE (P = .317). The area under the curve for CDE-OCT (0.98) was significantly higher than that for CDE (0.77) (P = .001). LIMITATIONS: Results are based on 2 OCT assessors. CONCLUSION: Compared with CDE alone, CDE-OCT results in a significantly higher ability to detect recurrent/residual BCCs after topical treatment.

Minimally invasive treatment of chronic iliofemoral venous occlusive disease.

BACKGROUND: As one of the primary etiologies of the post-thrombotic syndrome, chronic venous occlusion is a huge burden on patient quality of life and medical costs. In this study, we evaluate the short-term and midterm results of endovenous recanalization by angioplasty and stenting in chronic iliofemoral deep venous occlusions. METHODS: This is a retrospective observational study set in a tertiary medical referral center. Patients with venous claudication or C4-6 venous disease combined with duplex and magnetic resonance-confirmed iliofemoral or caval occlusion were included. Patients with recent deep vein thrombosis (<1 year) were excluded. The intervention was endovascular deep venous recanalization, followed by angioplasty and stenting. Safety and feasibility were clinically evaluated during the procedure and during follow-up. Reocclusions and other treatment failures were evaluated during a maximum follow-up of 31 months by ultrasound imaging and venography. RESULTS: Seventy-five procedures were performed in 63 patients (average age, 44 years; range, 18-75 years), of whom 86% had a history of deep venous thrombosis. The mean time between the initial deep venous thrombosis and treatment with PTA and stenting was 12 years (maximum, 31 years). May-Thurner syndrome was present in 57%. Forty-two procedures were performed in the left, six in the right, and 11 in both lower extremities. The vena cava inferior was partially stented in 25 patients. An average of 2.6 stents (median, 2) were used per procedure. Primary patency was 74% after 1 year. Assisted primary and secondary patency rates were 81% and 96%, respectively, at 1 year. Secondary procedures included restenting, catheter-directed thrombolysis, endophlebectomy of the common femoral vein, and creation of an arteriovenous fistula. No clinically evident pulmonary emboli were noted. A bleeding complication occurred after six procedures and was deemed major in two. No patients died. Relief or significant improvement of symptoms of chronic venous occlusive disease was achieved in 81% of patients. CONCLUSIONS: Endovenous recanalization by angioplasty and stenting of chronically occluded iliofemoral vein segments is a safe and effective treatment with good short-term results, even when treatment takes place decades after the initial deep venous thrombosis. Most reocclusions can be adequately treated by a secondary procedure.