Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Database | Search Strategy |
---|---|
PubMed | Onychomycosis AND confocal microscopy |
Embase | (Onychomycosis/OR fingernail onychomycosis/OR toenail onychomycosis/OR onychomycosis.mp) AND (reflectance confocal microscopy/OR confocal microscopy/OR reflectance confocal microscopy.mp OR confocal microscopy.mp) |
Scopus | TITLE-ABS-KEY (onychomycosis) AND TITLE-ABS-KEY (confocal AND microscopy) |
Cochrane | Onychomycosis in Title Abstract Keyword AND confocal microscopy in Title Abstract Keyword—(Word variations have been searched) |
First Author and Publication Year | Study Type | Number of Cases | Methods | Type of RCM Used | RCM Findings | Number of Cases with Positive RCM Findings | Diagnostic Accuracy |
---|---|---|---|---|---|---|---|
Hongcharu, 2000 [7] | Case report | 1 case of onychomycosis diagnosed on clinical assessment and KOH testing | In vivo and in vitro confocal infrared microscopy | RCM assembled using a range of laser-producing, scanning and detecting devices. A 1064 nm Nd:YAG laser was used. | - Network of branched hyphae in both in vivo and in vitro confocal images | 1 (100%) | ND |
Rothmund, 2012 [8] | Prospective cohort | 50 clinically suspicious cases of onychomycosis and 10 cases of controls (patients with nail disorders that did not display the typical clinical features of onychomycosis) | Comparison of the diagnostic accuracy of KOH, fungal culture, PCR, histology, in vivo RCM, and optical coherence tomography Onychomycosis diagnosed after positive KOH, culture, PCR or histology. | VivaScope 1500 with 830 nm laser in reflection mode | - Hyphae: lengthy, threadylike structures with high reflection - Sporelike aggregates with high reflection | 35 (58.3%): 34 in nails suspicious for onychomycosis; 1 in control group | Sensitivity 79.5% Specificity 81.0% PPV 88.6% NPV 68.0% |
Pharaon, 2014 [9] | Prospective cohort | 58 clinically suspicious cases of onychomycosis | Comparison of the diagnostic accuracy of KOH, fungal culture, and in vivo RCM. Two different RCM devices were used: a standard device and a handheld imager. Onychomycosis diagnosed after positive KOH and culture. | VivaScope 1500 and VivaScope 3000 (Lucid Inc, New York): both using an 830 nm laser in reflection mode | - Septate hyphae: aggregates of bright branching filamentous structures - Arthroconidia: bright roundish structures | 13 (22.4%) | Sensitivity 52.9% Specificity 90.2% PPV 69.2% NPV 82.2% |
Turan, 2015 [10] | Case report | 1 case of onychomycosis diagnosed on KOH testing and fungal culture | In vivo and in vitro confocal laser scanning microscopic examination. | Multilaser RCM using single wavelength laser of 786 nm | - Branching hyphae visualized as refractile, bright, linear structures situated just below the nail plate surface | 1 (100%) | ND |
Krammer, 2020 [11] | Prospective cohort | 57 clinically suspicious cases of onychomycosis | Comparison of the diagnostic accuracy of KOH, fungal culture, histology, and ex vivo RCM Onychomycosis diagnosed after positive KOH, culture or histology | Prototype VivaScope 2500 M-G4 (Lucid Inc, New York): using 488 nm (blue) and 785 nm (red) lasers | Hyphae demonstrated in images (specific describing words were not used) | 36 (63.2%) | Sensitivity 91.7% Specificity 57.6% PPV 61.1% NPV 90.5% |
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Lim, S.S.; Kim, B.R.; Mun, J.-H. Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review. J. Fungi 2022, 8, 1272. https://doi.org/10.3390/jof8121272
Lim SS, Kim BR, Mun J-H. Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review. Journal of Fungi. 2022; 8(12):1272. https://doi.org/10.3390/jof8121272
Chicago/Turabian StyleLim, Sophie Soyeon, Bo Ri Kim, and Je-Ho Mun. 2022. "Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review" Journal of Fungi 8, no. 12: 1272. https://doi.org/10.3390/jof8121272
APA StyleLim, S. S., Kim, B. R., & Mun, J.-H. (2022). Reflectance Confocal Microscopy in the Diagnosis of Onychomycosis: A Systematic Review. Journal of Fungi, 8(12), 1272. https://doi.org/10.3390/jof8121272