In Vivo Reflectance Confocal Microscopy in the Early Diagnosis of Acute Cutaneous Graft-Versus-Host Disease: A Pilot Study
Bibliographic record
Abstract
Graft-versus-host disease (GVHD) is a common and potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation. The diagnosis of cutaneous GVHD can be challenging, as it is based on clinical presentation, which often simulates other processes. Early recognition and treatment are essential to reduce the associated morbidity and mortality. Reflectance confocal microscopy (RCM) is a high-resolution, noninvasive technique that may facilitate a timely diagnosis and prompt institution of treatment. We sought to describe the features of acute cutaneous GVHD under RCM and to correlate these with the histopathological findings. Patients were recruited prospectively to undergo clinical and RCM examination. A total of 19 patients were enrolled, five of whom developed acute cutaneous GVHD following an allogeneic hematopoietic stem cell transplant. RCM images from these five cases were examined and the key confocal features were compared to histopathological findings. On RCM examination, features of acute cutaneous GVHD, such as apoptotic keratinocytes, inflammatory cell infiltration and interface dermatitis, were identified and were shown to correlate well with histopathological findings. The open-label, unblinded nature of this study allows for potential observer bias and the small sample size may not reflect the findings in a larger population. The sensitivity and specificity of RCM in this population remain to be determined. The findings support further examination of the use of RCM in the rapid, bedside diagnosis of acute cutaneous GVHD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".