Line-Field Confocal Optical Coherence Tomography Increases the Diagnostic Accuracy and Confidence for Basal Cell Carcinoma in Equivocal Lesions: A Prospective Study

Diagnosing clinically unclear basal cell carcinomas (BCCs) can be challenging. Line-field confocal optical coherence tomography (LC-OCT) is able to display morphological features of BCC subtypes with good histological correlation. The aim of this study was to investigate the accuracy of LC-OCT in diagnosing clinically unsure cases of BCC compared to dermoscopy alone and in distinguishing between superficial BCCs and other BCC subtypes. Moreover, we addressed pitfalls in false positive cases. We prospectively enrolled 182 lesions of 154 patients, referred to our department to confirm or to rule out the diagnosis of BCC. Dermoscopy and LC-OCT images were evaluated by two experts independently. Image quality, LC-OCT patterns and criteria, diagnosis, BCC subtype, and diagnostic confidence were assessed. Sensitivity and specificity of additional LC-OCT were compared to dermoscopy alone for identifying BCC in clinically unclear lesions. In addition, key LC-OCT features to distinguish between BCCs and non-BCCs and to differentiate superficial BCCs from other BCC subtypes were determined by linear regressions. Diagnostic confidence was rated as \u201chigh\u201d in only 48% of the lesions with dermoscopy alone compared to 70% with LC-OCT. LC-OCT showed a high sensitivity (98%) and specificity (80%) compared to histology, and these were even higher (100% sensitivity and 97% specificity) in the subgroup of lesions with high diagnostic confidence. Interobserver agreement was nearly perfect (95%). The combination of dermoscopy and LC-OCT reached a sensitivity of 100% and specificity of 81.2% in all cases and increased to sensitivity of 100% and specificity of 94.9% in cases with a high diagnostic confidence. The performance of LC-OCT was influenced by the image quality but not by the anatomical location of the lesion. The most specific morphological LC-OCT criteria in BCCs compared to non-BCCs were: less defined dermoepidermal junction (DEJ), hyporeflective tumor lobules, and dark rim. The most relevant features of the subgroup of superficial BCCs (sBCCs) were: string of pearls pattern and absence of epidermal thinning. Our diagnostic confidence, sensitivity, and specificity in detecting BCCs in the context of clinically equivocal lesions significantly improved using LC-OCT in comparison to dermoscopy only. Operator training for image acquisition is fundamental to achieve the best results. Not only the differential diagnosis of BCC, but also BCC subtyping can be performed at bedside with LC-OCT

Using Information-Seeking Argument Mining to Improve Service

If service providers can identify reasons users are in favor of or against a service, they have insightful information that can help them understand user behavior and what they need to do to change such behavior. This article argues that the novel text-mining technique referred to as information-seeking argument mining (IS-AM) can identify these reasons. The empirical study applies IS-AM to news articles and reviews about electric scooter-sharing systems (i.e., a service enabling the short-term rentals of electric motorized scooters). Its results point to IS-AM as a promising technique to improve service; the data enable the authors to identify 40 reasons to use or not use electric scooter-sharing systems, as well as their importance to users. Furthermore, the results show that news articles are better data sources than reviews because they are longer and contain more arguments and, thus, reasons

Accidental gynecomastia in children

Any palpable breast tissue in men is abnormal except during: the neonatal period, adolescence and in elderly age. Gynecomastia in prepubertal children may be due to enhanced endogenous oestrogen production, drugs or unknown causes. After the onset of puberty gynecomastia may also be due to a deficiency of testosterone. Young men and boys are particularly sensitive to oestrogens and may develop gynecomastia from exposure to industrial oestrogen, to creams containing oestrogens, to antiandrogens or to unrecognized endocrine substances. Furthermore gynecomastia and others pubertal disorders in males and females may be due to ingestion of food containing oestrogens or oestrogen-like substances; many "epidemics" of gynecomastia among children have been described. Hormones ingested by meat can cause breast enlagement and other deleterious immediate or long term effects. In particular it is a common concern among paediatricians and endocrine specialists that environmental and dietary "contaminants" may interfere with the pubertal development. In the evaluation of all this data we can not ignore the toxic effects of contamination may be having both in the short term but, more particularly, in the long term in terms of morbidity, mortality and therefore social costs