Figure 1 Sensitivity of CLSM in the diagnosis of (a) Malignant Melanoma and (b) Basal Cell Carcinoma.

Figure 2 Specificity of CLSM in the diagnosis of (a) Malignant Melanoma and (b) Basal Cell Carcinoma.

Figure 3 Positive likelihood ratio of CLSM in the diagnosis of (a) Malignant Melanoma and (b) Basal Cell Carcinoma.

Figure 4 Negative likelihood ratio of CLSM in the diagnosis of (a) Malignant Melanoma and (b) Basal Cell Carcinoma.

Figure 5Diagnostic odds ratio of CLSM in the diagnosis of (a) Malignant Melanoma and (b) Basal Cell Carcinoma.

Figure 6 SROC curve of CLSM for diagnosing (a) Malignant Melanoma and (b) Basal Cell Carcinoma.

Key words

Ovid embase

Ovid medline

Pubmed

Cochrane

Confocal microscopy

11769

9221

57839

0

Confocal laser scanning microscopy

2010

1436

57839

0

Reflectance confocal microscopy

102

146

607

0

Confocal microscopy AND skin cancer

34

50

461

0

Confocal microscopy AND histology

500

399

32157

0

Confocal microscopy AND skin cancer AND histology

3

4

358

0

Table1 The number of hits obtained from each database when searching for articles using key words

Ser
No

Study Author

Study Type

Evidence Level

Type Of Technique Used

Number Of Skin Cancer Lesions

Total Number Of Lesions*

Reference Standard

Blinding

Number Of Patients

Patient Characteristics

1

Nori S et al., 200421

Retrospective

Ib

In vivo CM

83

137

Histology

yes

145

Lesions 98 male specimens, 54 female specimen

2

Horn M et al., 200626

Retrospective

II

Ex vivo CM

20

40

Histology

yes

20

Not described

3

Gerger A et al., 200527

Prospective

II

In vivo CM

27

57

Histology

yes

57

Gender and age not mentioned. Location of lesions given as 15 on back, 6 on legs, 4 on head and 1 on acral skin

4

Langley R et al., 200728

Prospective

II

In vivo CM

37

125

Histology

no

125

Age range 16-84 yrs, mean age 44.2, no gender statistics

5

Guitera P
et al.,201029

Retrospective

II

In vivo CM

29

73

Histology

yes

73

Not described for test set

6

Curchin C et al.,201132

Retrospective

Ib

In vivo CM

13 MM

50

Histology

yes

42

Not described

9 BCC

7

Longo C
et al.,201330

Retrospective

II

In vivo CM

32 MM

140

Histology

yes

140

64 male,76 female

28 BCC

6 SCC

8

Guitera P et al.,201231

Retrospective

II

In vivo CM

105 MM

356

Histology

yes

Not Available

Total 663 patients, 309 females and 354 males. Median age 53 yrs. But patient characteristics not described separately for test set

52 BCC

Table 2Tabulated form of variables collected from the included studies

Ser
No

Studies

Type of Skin cancer

Average sensitivity (%)

Average
Specificity (%)

Average PPV
(Positive Predictive Value %)

Average NPV
(Negative Predictive Value %)

1

Nori S et al., 200421

BCC

82.9

95.7

97.18

78.79

2

Horn M et al., 200626

SCC

95

96.25

96.20

95.06

3

Gerger A et al., 200527

Melanoma

88.15

97.60

96

90.63

4

Langley R et al.,200728

Melanoma

97.3

83

70.59

98.65

5

Guitera P et al.,201029

 Melanoma

93

82

77.14

94.74

6

Curchin C et al.32

Melanoma

92.3

75

52.17

96.55

BCC

66.7

100

100

93.18

7

Longo C et al.,201330

 

Melanoma

96.5

94.1

83.78

99.03

BCC

100

99.1

96.55

100

SCC

78.12

87

21.62

98.89

8

Guitera P et al.,201231

Melanoma

87.6

70.8

55.76

93.19

BCC

100

88.5

59.77

100

Table 3Table showing sensitivities, specificities, PPV and NPV of the included studies

Skin Cancer type

Pooled Sensitivity

Pooled Specificity

Pooled Positive LR

Pooled Negative LR

Pooled DOR

 

Value

95% CI

Value

95% CI

Value

95% CI

Value

95% CI

Value

95% CI

 
Melanoma

0.914

0.871- 0.946

0.799

0.764 - 0.832

5.935

3.366 – 10.466

0.109

0.062- 0.190

80.075

23.438- 273.57

 Basal Cell Carcinoma

0.901

0.846 -0.941

0.926

0.899- 0.947

25.117

5.474-115.256

0.092

0.019-0.449

358.05

77.505- 1654.1

Table4 Table showing pooled sensitivities, specificities, LR and DOR of the included studies