Comparison of Noninvasive Methods for Diagnosing Basal Cell Carcinoma: A Network Meta-Analysis

BACKGROUND: Basal cell carcinoma (BCC) is the most common type of skin carcinoma affecting the elderly worldwide, and it is the central focus of this study. AIM AND OBJECTIVE: Our research aims to evaluate the diagnostic effectiveness of various methods, including dermatoscopy (DE), high-frequency ultrasound (HFU), optical coherence tomography (OCT), reflectance confocal microscopy (RCM), and histopathological examination (HPE). This comparison was accomplished through a network meta-analysis of patients diagnosed with BCC. MATERIALS AND METHODS: A comprehensive literature search was conducted across seven databases. Following this, both direct and indirect evidence were synthesized to assess the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each diagnostic method. This thorough analysis helped to estimate the odds ratios (ORs) for different methods and calculate the surface under the cumulative ranking curve (SUCRA) values, offering a deeper insight into the diagnosis of BCC. RESULTS: The network meta-analysis integrated data from six eligible diagnostic trials. The results revealed that dermoscopy combining optical coherence tomography (DE-OCT) achieved the highest sensitivity (88.8%), specificity (70.7%), and NPV (84.2%), with the highest SUCRA value, indicating superior diagnostic performance. However, dermoscopy combining high-frequency ultrasound (DE-HFU) demonstrated the highest accuracy (90.1%) and PPV (73.8%). The sensitivity and accuracy for OCT (55.5%, 47.4%) and RCM (52.2%, 55.7%) were similar, with both methods ranking highest in these aspects. LIMITATIONS: This network meta-analysis has several limitations, including the limited number of comparisons and potential heterogeneity across the original studies. CONCLUSION: This network meta-analysis found DE-OCT and DE-HFU most effective for BCC diagnosis, but further validation in larger studies is needed. Still, it offers initial guidance for clinical tool selection.