CC BY
14B-O-10
BIOMEDICAL PHOTONICS
Non-invasive diagnosis of histopathological patterns in vulvar dermatoses by multimodal optical coherence tomography
A. Potapov1, M. Sirotkina1, M. Karabut1, I. Kuznetsova2, S. Radenska-Lopovok3 and N. Gladkova1
1- Privolzhsky Research Medical University, 603950, 10/1, Minin and Pozharsky sq., Nizhny Novgorod, Russia;
2- N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, 603126, 190, Rodionova str., Nizhny Novgorod, Russia;
3- I.M. Sechenov First Moscow State Medical University (Sechenov University), 8, Trubetskaya str., Moscow, Russia.
Arseniy1109@gmail.com
Accurate clinical diagnosis of skin inflammatory diseases of the vulvar area today remains a challenge. Caused by nonspecific skin manifestations as well as the warm, moist, frictional environment of the vulva obscures characteristic morphologic hallmarks [1]. This is due to nonspecific skin manifestations, as well as the fact that the warm, humid, frictional environment of the vulva obscures the characteristic morphological features. Histopathological diagnostics, as a reference method, has limitations due to its traumatic nature, a small area of the tissue being examined, and also due to the complexity of such diagnostics in the early stages of diseases. In the absence of a specific histopathological diagnosis, the physician is provided with a description of the histopathological pattern, and the final diagnosis is made clinicopathologically. The pattern approach allows narrowing the range of diagnostic search, as some of the suspicious diagnoses are excluded [1].
In this paper, we propose multimodal optical coherence tomography (MM OCT) as a non-invasive diagnostic technique of histopathological patterns in vulvar dermatoses. The MM OCT provides 3D (3.4^3.4x1.25 mm) real-time visualization of the vulvar skin structure with a spatial resolution of 10-20 microns at a depth of 1-2 mm, as well as label-free visualization of blood and lymphatic vessels. The study involved 16 patients with a clinical diagnosis of vulvar dermatoses and 5 patients without vulvar diseases. Parallel MM OCT and histopathological examination were performed.
The acanthotic pattern is characterized by a layered tissue structure with pronounced thickening of the epidermis on the OCT b-scan. In some cases, acanthotic ridges are visualized, but they are usually masked due to the optical homogeneity of the dermal-epidermal junction. OCT angio- and lymphangiography demonstrates good vascularization of the dermis.
The lichenoid pattern is characterized by a high signal level in the b-scan OCT co-channel from a band-like inflammatory infiltrate, since numerous cell nuclei act as scatterers. If the inflammatory infiltrate is located under the epidermis, then the layered structure of the tissue is preserved, and the dermal-epidermal junction is emphasized. When the infiltrate penetrates the epidermis, the layered structure of the tissue is disturbed.
The dermal homogenization pattern is characterized by the formation of homogeneous masses in the dermis that do not scatter light back, making these areas dark on the OCT b-scan. Homogenization areas have different signal intensity in co- and cross-channels of OCT, it depends on the length and thickness of collagen fibers, the presence of edema and inflammatory cells. OCT angio- and lymphangiography demonstrates impaired tissue vascularization [2].
The vesiculobullouspattern is characterized by the formation of fluid-filled cavities in the dermis. Such areas have a zero signal in both co- and cross-channel OCT.
In conclusion, non-invasive MM OCT effectively identifies histopathological patterns, which can be used as basic information for the clinicopathological diagnosis of vulvar dermatoses.
The study was financially supported by Russian Science Foundation project No19-75-10084.
[1] P.J. Lynch, M. Moyal-Barracco, F. Bogliatto, L. Micheletti, J. Scurry, 2006 ISSVD classification of vulvar dermatoses: pathologic subsets and their clinical correlates, The Journal of reproductive medicine, Vol. 52(1), pp. 3-9, (2007).
[2] M. A. Sirotkina, A. L. Potapov, M.M. Karabut, N. N. Vagapova, A. A. Moiseev, S. S. Kuznetsov, S. G. Radenska-Lopovok, I. A. Kuznetsova, and N. D. Gladkova, Multimodal OCT for in-vivo diagnosis of vulvar lichen sclerosus and evaluate the therapy
success, Proc. SPIE 11924, Optical Coherence Imaging Techniques and Imaging in Scattering Media IV, 1192419 (2021).
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