Machine Learning Analysis of Two-photon Fluorescence Microscopy of Dermatologic Biopsies

This study will image biopsy specimens at point of care using two-photon fluorescence microscopy (TPFM) and then assess how well the images predict the eventual clinical diagnosis using a machine learning model. Because two-photon images can be acquired from small biopsy specimens within minutes of excision, they could potentially be used to immediately diagnose patients, but the accuracy of TPFM for various skin conditions is unknown.

Individual biopsy specimens in a dermatology clinic will be imaged using TPFM shortly after biopsy procedures. Immediately following imaging, a machine learning model will evaluate the TPFM images then compute a confidence score for a diagnosis of basal cell carcinoma (BCC), squamous cell carcinoma, and non-cancer. The relative confidence in each diagnosis will be compared, and if sufficient confidence is achieved, the model will render a diagnosis or else flag the specimen as indeterminate for manual pathologist review. This workflow will evaluate the use of ML + TPFM to perform point of care diagnosis of skin lesions.

Following TPFM imaging, the specimen will be submitted for histological processing, which will guide actual patient treatment. Following conclusion of patient treatment, the resulting histology slides will be scanned for comparison and the final patient diagnosis recorded. Images of the histology slides will be read by a pathologist to establish a gold-standard diagnosis. The official diagnosis and the diagnosis from the collaborating pathologist will be compared.

Patient treatment will still be decided by conventional histopathology. TPFM will not be used to change treatment.

Inclusion criteria

• Punch, excisional or shave biopsy specimen

Exclusion criteria

• Biopsy indication includes melanoma or dysplastic/atypical nevus
• Excision thickness of less than 1 mm
• Excision longest dimension less than 2 mm
• Excision performed as multiple pieces in a single specimen container