The Impact of Clinical and Dermoscopic Photographs on the Diagnostic Accuracy of Remote Optical Coherence Tomography Assessment for Basal Cell Carcinoma Detection: A Comparative Diagnostic Study

Background Remote assessment of optical coherence tomography (OCT) scans for basal cell carcinoma (BCC) detection enhances access to OCT-guided dermatologic care, but prohibits direct lesion inspection. The value of clinical and dermoscopic photographs when remotely assessing OCT scans remains unknown. The objective was to evaluate the impact of leaving out clinical and dermoscopic photographs on the diagnostic accuracy of remote OCT assessment. The primary question was whether an unacceptable decrease in specificity (>= 10%) could be excluded when photographs are not provided.Methods In a diagnostic study, four OCT assessors assessed 120 scans of clinically equivocal lesions suspect for BCC with an indication for biopsy. Assessments were initially conducted without photographs, after which cases were shuffled and reassessed alongside photographs. Assessors expressed diagnostic certainty on a five-point confidence scale. Only certainty about BCC presence and its subtype was considered a positive test result. Histopathology served as the reference standard.Results Assessment without photographs led to a change of specificity ranging from -1.7% to +6.7%. According to the lower limits of the one-sided 95% confidence interval around the changes, a decrease of more than 10% could be excluded. Sensitivity decreased in three of the four assessors.Conclusions Leaving out photographs does not compromise specificity, and in this respect it is considered non-inferior to remote OCT assessment with photographs. However, assessment with photographs increases the proportion of BCCs detected and is therefore recommended.Trial Registration NCT06273709