Exfoliative cytology for diagnosing basal cell carcinoma and other skin cancers in adults

Early accurate detection of all skin cancer types is essential to guide appropriate management, reduce morbidity and improve survival. Basal cell carcinoma (BCC) is usually localised to the skin but has potential to infiltrate and damage surrounding tissue, while cutaneous squamous cell carcinoma (c...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2018-12, Vol.12 (12), p.CD013187-CD013187
Main Authors: Ferrante di Ruffano, Lavinia, Dinnes, Jacqueline, Chuchu, Naomi, Bayliss, Susan E, Takwoingi, Yemisi, Davenport, Clare, Matin, Rubeta N, O'Sullivan, Colette, Roskell, Derek, Deeks, Jonathan J, Williams, Hywel C
Format: Article
Language:English
Subjects:
Adult
Azure Stains
Cancer
Carcinoma, Basal Cell - diagnosis
Carcinoma, Basal Cell - pathology
Carcinoma, Squamous Cell - diagnosis
Carcinoma, Squamous Cell - pathology
Coloring Agents
Cytodiagnosis - methods
Dermoscopy
Diagnosis
Humans
Melanoma - pathology
Melanoma, Cutaneous Malignant
Papanicolaou Test
Sensitivity and Specificity
Skin disorders
Skin Neoplasms - diagnosis
Skin Neoplasms - pathology
X. TUMOURS AND CYSTS OF THE SKIN AND APPENDAGES
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Summary:Early accurate detection of all skin cancer types is essential to guide appropriate management, reduce morbidity and improve survival. Basal cell carcinoma (BCC) is usually localised to the skin but has potential to infiltrate and damage surrounding tissue, while cutaneous squamous cell carcinoma (cSCC) and melanoma have a much higher potential to metastasise and ultimately lead to death. Exfoliative cytology is a non-invasive test that uses the Tzanck smear technique to identify disease by examining the structure of cells obtained from scraped samples. This simple procedure is a less invasive diagnostic test than a skin biopsy, and for BCC it has the potential to provide an immediate diagnosis that avoids an additional clinic visit to receive skin biopsy results. This may benefit patients scheduled for either Mohs micrographic surgery or non-surgical treatments such as radiotherapy. A cytology scrape can never give the same information as a skin biopsy, however, so it is important to better understand in which skin cancer situations it may be helpful. To determine the diagnostic accuracy of exfoliative cytology for detecting basal cell carcinoma (BCC) in adults, and to compare its accuracy with that of standard diagnostic practice (visual inspection with or without dermoscopy). Secondary objectives were: to determine the diagnostic accuracy of exfoliative cytology for detecting cSCC, invasive melanoma and atypical intraepidermal melanocytic variants, and any other skin cancer; and for each of these secondary conditions to compare the accuracy of exfoliative cytology with visual inspection with or without dermoscopy in direct test comparisons; and to determine the effect of observer experience. We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We also studied the reference lists of published systematic review articles. Studies evaluating exfoliative cytology in adults with lesions suspicious for BCC, cSCC or melanoma, compared with a reference standard of histological confirmation. Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-
ISSN:1469-493X
DOI:10.1002/14651858.CD013187