Sensitivity and Specificity Analysis of Different Lesion Areas of Vitiligo by Reflectance Confocal Microscopy

Background

Clinical diagnosis and staging of vitiligo often rely on the patient's subjective recollection, physician's experience, or clinical evaluation methods. An objective, quantitative diagnostic approach is lacking.

Aims

This study was performed to compare the sensitivity and specificity of different lesion areas and full scanning of lesion areas using reflectance confocal microscopy (RCM) for diagnosis and staging of vitiligo.

Methods

Clinical and RCM data of patients diagnosed with vitiligo were collected. RCM data were gathered from three sites of a lesion: the center of the lesion, the margin of the lesion, and the perilesional normal skin. Scoring was conducted for each method, categorizing the results as either the progressive or stable stage of vitiligo.

Results

The sensitivity was significantly lower in the perilesional normal skin than at multiple sites (p < 0.001). The specificity was significantly lower in the center of the lesion and at the margin than at multiple sites and significantly higher in the perilesional normal skin than at multiple sites (p < 0.05 for all).

Conclusions

The results of RCM of different lesion areas of vitiligo showed that the rate of missed diagnosis of the progressive stage was lowest in the center of the lesion and comparable to that of multiple sites. The misdiagnosis rate for the stable stage was lowest in the perilesional normal skin, significantly differing from the other sites. Overall, scanning multiple sites yielded the most accurate results, offering flexibility in selection according to the patient's compliance.