The Value of In Vivo Reflectance Confocal Microscopy as an Assessment Tool in Chemotherapy-Induced Peripheral Neuropathy: A Pilot Study

TY - JOUR

T1 - The Value of In Vivo Reflectance Confocal Microscopy as an Assessment Tool in Chemotherapy-Induced Peripheral Neuropathy

T2 - A Pilot Study

AU - Ramnarine, Sabrina R.

AU - Dougherty, Patrick M.

AU - Rolke, Roman

AU - Williams, Linda J.

AU - Alessi-fox, Christi

AU - Coleman, Andrew J.

AU - Longo, Caterina

AU - Colvin, Lesley A.

AU - Fallon, Marie T.

N1 - Funding Information: This work was supported by The Melville Trust for the Care and Cure of Cancer (Clinical Research Fellowship), The Mason Medical Research Foundation (Research Fellowship), and the Edinburgh Cancer Research Centre, Institute of Genetics & Molecular Medicine, University of Edinburgh (to S.R.R). R.R. is funded by a grant from the Interdisciplinary Centre for Clinical Research within the Faculty of Medicine at the RWTH Aachen University [TN1-6/IA 532006] and by the BMBF consortium “Bio2Treat” (German Federal Ministry of Education and Research/Bundesministerium für Bildung und Forschung, BMBF, “Chronische Schmerzen—Innovative medizintechnische Lösungen zur Verbesserung von Prävention, Diagnostik und Therapie,” contract number 13GW0334B). © The Author(s) 2022. Published by Oxford University Press.

PY - 2022/8

Y1 - 2022/8

N2 - BACKGROUND: There is a lack of standardized objective and reliable assessment tools for chemotherapy-induced peripheral neuropathy (CIPN). In vivo reflectance confocal microscopy (RCM) imaging offers a non-invasive method to identify peripheral neuropathy markers, namely Meissner's corpuscles (MC). This study investigated the feasibility and value of RCM in CIPN. PATIENTS AND METHODS: Reflectance confocal microscopy was performed on the fingertip to evaluate MC density in 45 healthy controls and 9 patients with cancer (prior, during, and post-chemotherapy). Quantification was completed by 2 reviewers (one blinded), with maximum MC count/3 × 3 mm image reported. Quantitative Sensory Testing (QST; thermal and mechanical detection thresholds), Grooved pegboard test, and patient-reported outcomes measures (PROMS) were conducted for comparison. RESULTS: In controls (25 females, 20 males; 24-81 years), females exhibited greater mean MC density compared with males (49.9 ± 7.1 vs 30.9 ± 4.2 MC/3 × 3 mm; P = .03). Differences existed across age by decade (P < .0001). Meissner's corpuscle density was correlated with mechanical detection (ρ = -0.51), warm detection (ρ = -0.47), cold pain (ρ = 0.49) thresholds (P < .01); and completion time on the Grooved pegboard test in both hands (P ≤ .02). At baseline, patients had reduced MC density vs age and gender-matched controls (P = .03). Longitudinal assessment of MC density revealed significant relationships with QST and PROMS. Inter-rater reliability of MC count showed an intraclass correlation of 0.96 (P < .0001). CONCLUSIONS: The findings support the clinical utility of RCM in CIPN as it provides meaningful markers of sensory nerve dysfunction. Novel, prospective assessment demonstrated the ability to detect subclinical deficits in patients at risk of CIPN and potential to monitor neuropathy progression.

AB - BACKGROUND: There is a lack of standardized objective and reliable assessment tools for chemotherapy-induced peripheral neuropathy (CIPN). In vivo reflectance confocal microscopy (RCM) imaging offers a non-invasive method to identify peripheral neuropathy markers, namely Meissner's corpuscles (MC). This study investigated the feasibility and value of RCM in CIPN. PATIENTS AND METHODS: Reflectance confocal microscopy was performed on the fingertip to evaluate MC density in 45 healthy controls and 9 patients with cancer (prior, during, and post-chemotherapy). Quantification was completed by 2 reviewers (one blinded), with maximum MC count/3 × 3 mm image reported. Quantitative Sensory Testing (QST; thermal and mechanical detection thresholds), Grooved pegboard test, and patient-reported outcomes measures (PROMS) were conducted for comparison. RESULTS: In controls (25 females, 20 males; 24-81 years), females exhibited greater mean MC density compared with males (49.9 ± 7.1 vs 30.9 ± 4.2 MC/3 × 3 mm; P = .03). Differences existed across age by decade (P < .0001). Meissner's corpuscle density was correlated with mechanical detection (ρ = -0.51), warm detection (ρ = -0.47), cold pain (ρ = 0.49) thresholds (P < .01); and completion time on the Grooved pegboard test in both hands (P ≤ .02). At baseline, patients had reduced MC density vs age and gender-matched controls (P = .03). Longitudinal assessment of MC density revealed significant relationships with QST and PROMS. Inter-rater reliability of MC count showed an intraclass correlation of 0.96 (P < .0001). CONCLUSIONS: The findings support the clinical utility of RCM in CIPN as it provides meaningful markers of sensory nerve dysfunction. Novel, prospective assessment demonstrated the ability to detect subclinical deficits in patients at risk of CIPN and potential to monitor neuropathy progression.

KW - peripheral neuropathy

KW - neurotoxic chemotherapy

KW - in vivo reflectance confocal microscopy

KW - Meissner’s corpuscles

KW - Quantitative Sensory Testing

KW - patient-reported outcome measures

UR - https://www.scopus.com/pages/publications/85135599142

U2 - 10.1093/oncolo/oyac106

DO - 10.1093/oncolo/oyac106

M3 - Article

C2 - 35706109

SN - 1083-7159

VL - 27

SP - e671-e680

JO - Oncologist

JF - Oncologist

IS - 8

ER -