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Gellrich FF, Laske J, Steininger J, Eberl N, Meier F, Beissert S, Hobelsberger S. Ex Vivo Confocal Microscopy Speeds up Surgical Margin Control of Re-Excised Skin Tumors and Greatly Shortens In-Hospital Stay. Cancers (Basel) 2024; 16:3209. [PMID: 39335180 PMCID: PMC11429506 DOI: 10.3390/cancers16183209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/08/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES To ensure that non-melanoma skin cancer (NMSC) is completely removed in healthy tissue, micrographically controlled surgery (3D histology) is often performed, which can prolong the inpatient stay. This study examined ex vivo reflectance confocal microscopy (evRCM) for perioperative assessment of surgical margins, specifically in cases where re-excision was necessary due to incomplete removal of cutaneous tumor tissue. METHODS NMSC re-excisions were evaluated using evRCM by a cutaneous surgeon, with retrospective review by an independent pathologist when results differed from histology. RESULTS evRCM demonstrated high specificity (0.96; 95% CI, 0.90-0.99) but low sensitivity (0.20; 95% CI, 0.06-0.51). Unlike pathology, which discards outer surgical margins, evRCM examined the true surgical margins. Retrospective pathology analysis of the misdiagnosed cases confirmed that 25% (n = 2/8) were false negative and 75% (n = 6/8) were potentially false positive, resulting in a sensitivity of 0.2-0.8. Notably, evRCM led to a 113-day reduction in in-hospital stays, probably resulting in increased patient satisfaction and cost-effectiveness. CONCLUSIONS evRCM was valuable for speeding up the assessment of surgical margins in patients with re-excised NMSC. Proper tissue preparation and assessment require interdisciplinary collaboration between cutaneous surgeons, pathologists, and physician assistants, emphasizing the need for standardized operating procedures.
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Affiliation(s)
- Frank Friedrich Gellrich
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Jörg Laske
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Julian Steininger
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Nadia Eberl
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Stefan Beissert
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
| | - Sarah Hobelsberger
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, 01307 Dresden, Germany; (J.L.); (J.S.); (N.E.); (F.M.); (S.B.); (S.H.)
- Skin Cancer Center at the University Cancer Center, 01307 Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany
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A Feasibility Study for Immediate Histological Assessment of Various Skin Biopsies Using Ex Vivo Confocal Laser Scanning Microscopy. Diagnostics (Basel) 2022; 12:diagnostics12123030. [PMID: 36553036 PMCID: PMC9777122 DOI: 10.3390/diagnostics12123030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Digitally stained ex vivo confocal laser scanning microscopy (CLSM) scans are a possible alternative to formalin-fixed and paraffin-embedded (FFPE) and hematoxylin-eosin (H&E) stained slides. This study explores the diagnostic accuracy of digitally-stained CLSM scans in comparison to H&E-stained slides in various dermatologic diseases in a real-life setting. METHODS Samples of patients out of one selected dermatologic office were primarily scanned via CLSM; a diagnosis was made afterwards using FFPE- and H&E-stained slides by two experienced dermatopathologists. Primary outcomes were sensitivity and specificity of diagnosis in digitally stained CLSM scans in three separate diagnostic groups. RESULTS CLSM evaluation of epithelial tumors (n = 132) demonstrated a sensitivity of 64.3%/83.9% and a specificity of 84.2%/71.1%. Diagnosis of melanocytic tumors (n = 86) showed a sensitivity of 19.1%/85.1% and a specificity of 96.3%/66.7%. In the diagnosis of other tumors/cysts and inflammatory dermatoses (n = 42), a sensitivity of 96.4%/96.8% and a specificity of 57.1%/45.5% was reached. CONCLUSIONS This study shows the possibilities and limitations of a broad use of CLSM. Because of a partly low diagnostic accuracy, such an application does not seem to be recommendable at present for every indication.
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Park WY, Kim B, Chun JH, Hong SM, Oh BH, Kim KH. High-contrast visualization of human skin cancers with combined reflectance confocal and moxifloxacin-based two-photon microscopy: An ex vivo study. Lasers Surg Med 2022; 54:1226-1237. [PMID: 36087014 DOI: 10.1002/lsm.23600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/18/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Precise determination of cancer margin during skin cancer surgery is crucial for complete resection and further clinical prognosis. Although reflection confocal microscopy (RCM) has been used for perioperative guiding, its reflection contrast has limitations in detecting cancer cells in the dermis. We previously developed combined reflection confocal (RC) and moxifloxacin-based two-photon (MB-TP) microscopy for sensitive cancer detection by using multiple contrast mechanisms. In this study, the performance of combined microscopy was characterized in various skin cancer specimens and compared with standard methods. MATERIALS AND METHODS Seven human skin specimens in total including two normal ones, three basal cell carcinomas (BCCs), and two squamous cell carcinomas (SCCs) were collected and imaged in fresh condition. Moxifloxacin ophthalmic solution was topically instilled for cell labeling for 3-5 minutes, then mosaic imaging with the combined microscopy was conducted. The imaged specimens were imaged again after exogenous nuclear labeling for comparison and then processed for standard hematoxylin and eosin histology. RESULTS Combined RC and MB-TP microscopy visualized both cell and extracellular matrix structures of the skin specimens with multiple contrasts of reflection, moxifloxacin fluorescence, autofluorescence, and second harmonic generation. It distinguished normal cell structures in the skin dermis such as hair follicles, sebaceous and eccrine glands from BCC nests, and SCCs based on cell organization. Normal cell structures had organized cell arrangements for their functions, while cancer cell structures had dense and disorganized cell arrangements. Cellular features found by combined microscopy images were confirmed by both TP microscopy with nuclear labeling and histological examination. CONCLUSIONS The imaging results showed the potential of combined microscopy for sensitive cancer detection and in vivo guiding of skin cancer surgery.
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Affiliation(s)
- Won Yeong Park
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Bumju Kim
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Ji Hyun Chun
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Ho Oh
- Department of Dermatology, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea.,Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
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Grizzetti L, Kuonen F. Ex vivo confocal microscopy for surgical margin assessment: A histology-compared study on 109 specimens. SKIN HEALTH AND DISEASE 2022; 2:e91. [PMID: 35677928 PMCID: PMC9168011 DOI: 10.1002/ski2.91] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/13/2022]
Abstract
Background The assessment of surgical margins is mandatory to prevent local recurrence or distant dissemination of skin cancers. Histological examination of haematoxylin and eosin (H&E)-stained slides from paraffin-embedded or frozen samples is the gold standard for margin assessment, but is a time-consuming procedure. Ex vivo confocal laser scanning microscopy (CLSM) is an upcoming technique that scans unfixed fresh tissue rapidly, allowing fast per-operative margin assessment. Objective Here, we propose to assess the efficiency of a new ex vivo confocal microscope for the per-operative assessment of surgical margins. Methods We analyzed 16 biopsies and 93 surgical specimens of basal cell and squamous cell carcinomas by ex vivo CLSM using Histolog® Scanner V2. Surgical specimens included fusiform excisions, slow-Mohs peripheral and deep compartments, and Mohs excisions. The time required from surgical excision to image analysis was recorded and the quality of the images obtained for each specimen assessed. The presence or absence of tumour was estimated based on ex vivo CLSM images and compared with conventional H&E-stained sections from paraffin-embedded or frozen (Mohs) specimens. Results Mean time for specimen processing using Histolog Scanner was 5.1 ± 3.4 min. We obtained 89% of high quality images. Mean time for confocal image analysis was 1 ± 0.76 min. The diagnostic sensitivity and specificity for ex vivo CLSM compared to classical H&E procedures were respectively 93% and 100% when performed on tumour biopsies. The overall sensitivity and specificity for ex vivo CLSM for margin assessment compared to classical H&E procedures were respectively 61.5% and 95%, with variations depending on the type of tumour or surgical specimen analyzed. In particular, we obtained 80% sensitivity and 100% specificity for the assessment of BCC surgical margins. Conclusion Our data suggest that ex vivo CLSM using Histolog® Scanner V2 could be a valid help for surgeons for a fast and accurate per-operative margin analysis.
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Affiliation(s)
- L. Grizzetti
- Department of Dermatology and Venereology, Hôpital de BeaumontLausanne University Hospital CenterLausanneSwitzerland
| | - F. Kuonen
- Department of Dermatology and Venereology, Hôpital de BeaumontLausanne University Hospital CenterLausanneSwitzerland
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5
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Bergeret B, Masset F, Bekoy YD, Roger P, Habib F, Ovtchinnikoff B, Meunier L, Stoebner PE. Diagnostic Accuracy of Digital Staining ex vivo Confocal Microscopy for Diagnosing and Subtyping Basal Cell Carcinoma in Fresh Pretherapeutic Punch Biopsies: A Monocentric Prospective Study. Dermatology 2022; 238:1-7. [PMID: 35512658 DOI: 10.1159/000524349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ex vivo confocal microscopy using fusion mode and digital staining (EVCM) scans unfixed fresh tissue and produces rapidly digitally stained images of very similar quality to classical pathology. We investigated whether EVCM could represent an alternative to the standard histological examination of the pretherapeutic basal cell carcinoma (BCC) punch biopsies. OBJECTIVES The objective of the study was to assess diagnostic accuracy of EVCM versus traditional histopathological examination for diagnosing and subtyping clinically suspicious lesions of BCC in 3-mm fresh and nonfixed punch biopsies. METHODS In this prospective monocentric observational study, patients with clinically suspected BCC were consecutively enrolled. Punch biopsies were imaged using EVCM and subsequently processed for standard histologic examination (gold standard). EVCM images were examined by a dermatopathologist blinded to clinical aspect of the lesion and histopathological results. Concordance between the EVCM and histology analysis was calculated with Cohen's kappa (κ) statistic. RESULTS Sixty-six patients were recruited, and 106 biopsies were analyzed. EVCM correctly diagnosed 70/73 BCCs and 31/33 non-BCC lesions, corresponding to a sensitivity of 96% and a specificity of 94% (positive predictive value = 97%, negative predictive value = 91%). The EVCM assessment led to over-staging and under-staging of BCC subtypes in 5% and 11% of cases, respectively. It led to over-staging and under-staging of BCC depths in 5% and 15%, respectively. The kappa coefficient for concordance was 0.78 (95% confidence interval [CI]: 0.69-0.88) when considering BCC subtypes and 0.81 (95% CI: 0.72-0.90) when considering BCC depths. CONCLUSIONS These results render EVCM as a promising option for "real-time" pretreatment evaluation of clinically suspected BCC lesions. Further larger randomized studies are needed to assess the efficiency of EVCM versus standard care in patients with clinically suspected BCC.
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Affiliation(s)
- Blanche Bergeret
- Department of Dermatology, CHU Nîmes, Nîmes, France
- Faculty of Medicine, Montpellier University, Montpellier, France
| | | | - Yona D Bekoy
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Nîmes, France
| | - Pascal Roger
- Faculty of Medicine, Montpellier University, Montpellier, France
- Department of Anatomopathology, CHU Nîmes, Nîmes, France
| | | | | | - Laurent Meunier
- Faculty of Medicine, Montpellier University, Montpellier, France
- Department of Dermatology, CHU Montpellier, Montpellier, France
| | - Pierre E Stoebner
- Department of Dermatology, CHU Nîmes, Nîmes, France
- Faculty of Medicine, Montpellier University, Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Montpellier, France
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6
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Grupp M, Illes M, Mentzel J, Simon JC, Paasch U, Grunewald S. Schnittrandkontrolle von Basalzellkarzinomen mittels
ex‐vivo
konfokaler Laserscanmikroskopie mit digitaler Farbbearbeitung – Anwendung in der Routinediagnostik. J Dtsch Dermatol Ges 2021; 19:685-693. [PMID: 33979047 DOI: 10.1111/ddg.14374_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/19/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Margarethe Grupp
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Monica Illes
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Julia Mentzel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Jan C Simon
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Uwe Paasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - Sonja Grunewald
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Leipzig
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Boitor R, de Wolf C, Weesie F, Shipp DW, Varma S, Veitch D, Wernham A, Koloydenko A, Puppels G, Nijsten T, Williams HC, Caspers P, Notingher I. Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma. BIOMEDICAL OPTICS EXPRESS 2021; 12:2015-2026. [PMID: 33996213 PMCID: PMC8086475 DOI: 10.1364/boe.417896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 05/31/2023]
Abstract
We present the first clinical integration of a prototype device based on integrated auto-fluorescence imaging and Raman spectroscopy (Fast Raman device) for intra-operative assessment of surgical margins during Mohs micrographic surgery of basal cell carcinoma (BCC). Fresh skin specimens from 112 patients were used to optimise the tissue pre-processing and the Fast Raman algorithms to enable an analysis of complete Mohs layers within 30 minutes. The optimisation allowed >95% of the resection surface area to be investigated (including the deep and epidermal margins). The Fast Raman device was then used to analyse skin layers excised from the most relevant anatomical sites (nose, temple, eyelid, cheek, forehead, eyebrow and lip) and to detect the three main types of BCC (nodular, superficial and infiltrative). These results suggest that the Fast Raman technique is a promising tool to provide an objective diagnosis "tumour clear yes/no" during Mohs surgery of BCC. This clinical integration study is a key step towards a larger scale diagnosis test accuracy study to reliably determine the sensitivity and specificity in a clinical setting.
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Affiliation(s)
- Radu Boitor
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Coen de Wolf
- Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
| | - Frank Weesie
- Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
| | - Dustin W. Shipp
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Sandeep Varma
- Nottingham NHS Treatment Centre, Nottingham University Hospitals, Lister Rd, Nottingham NG7 2FT, United Kingdom
| | - David Veitch
- Nottingham NHS Treatment Centre, Nottingham University Hospitals, Lister Rd, Nottingham NG7 2FT, United Kingdom
| | - Aaron Wernham
- Nottingham NHS Treatment Centre, Nottingham University Hospitals, Lister Rd, Nottingham NG7 2FT, United Kingdom
| | - Alexey Koloydenko
- Mathematics Department, Royal Holloway University of London, Egham, TW20 OEX, United Kingdom
| | - Gerwin Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
- RiverD International B.V., Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
| | - Hywel C. Williams
- Centre for Evidence Based Dermatology, Nottingham University Hospital NHS Trust, QMC Campus, Derby Road, Nottingham NG7 2UH, United Kingdom
| | - Peter Caspers
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, Rotterdam 3015 GD, The Netherlands
- RiverD International B.V., Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - Ioan Notingher
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
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Grupp M, Illes M, Mentzel J, Simon JC, Paasch U, Grunewald S. Routine application of ex vivo confocal laser scanning microscopy with digital staining for examination of surgical margins in basal cell carcinomas. J Dtsch Dermatol Ges 2021; 19:685-692. [PMID: 33768732 DOI: 10.1111/ddg.14374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Ex vivo confocal laser scanning microscopy (CLSM) allows histologic examination of native tissue based on tissue reflection and nuclear fluorescence staining. The newly introduced digital staining process almost perfectly mimics conventional hematoxylin and eosin (HE) slides. The aim was to evaluate the new method in clinical routine, with regard to quality of findings and time requirements, in the examination of surgical margins of basal cell carcinomas. PATIENTS AND METHODS 78 patients with 101 basal cell carcinomas were prospectively enrolled. Surgery was performed either with complete margin control (n = 60) or as elliptical excision (n = 41). Immediately after excision specimens were scanned with CLSM and then routinely processed by conventional histopathology. Blinded evaluation of images and slides was performed by a dermatopathologist. RESULTS Basal cell carcinomas were excellently recognizable by CLSM directly after excision, and the use of digital staining did not require any adjustment of the examiner's visualization preferences. CLSM images showed a sensitivity of 73.6 % and a specificity of 96.5 % compared to conventional HE stained slides. Erroneous findings were often due to limited assessment potential in cases where the epidermis could not be fully visualized. CONCLUSIONS CLSM with digital HE staining is very well suited to diagnose basal cell carcinomas and their incision margins even under routine conditions and thus represents a tissue-saving alternative to rapid cryostat sectioning.
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Affiliation(s)
- Margarethe Grupp
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Monica Illes
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Julia Mentzel
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Jan C Simon
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Uwe Paasch
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Sonja Grunewald
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig AöR, Leipzig, Germany
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9
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Kose K, Fox CA, Rossi A, Jain M, Cordova M, Dusza SW, Ragazzi M, Gardini S, Moscarella E, Diaz A, Pigem R, Gonzalez S, Bennassar A, Carrera C, Longo C, Rajadhyaksha M, Nehal KS. An international 3-center training and reading study to assess basal cell carcinoma surgical margins with ex vivo fluorescence confocal microscopy. J Cutan Pathol 2021; 48:1010-1019. [PMID: 33576022 DOI: 10.1111/cup.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. OBJECTIVE To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. METHODS An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. RESULTS Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. LIMITATIONS Small dataset, variability in mosaic quality between centers. CONCLUSION Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
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Affiliation(s)
- Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Manu Jain
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moira Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - Stefano Gardini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania L Vanvitelli, Naples, Italy
| | - Alba Diaz
- Pathology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Pigem
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Salvador Gonzalez
- Medicine and Medical Specialties Department, Alcalá de Henares University, Madrid, Spain
| | - Antoni Bennassar
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Madrid, Spain
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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10
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Malvehy J, Pérez-Anker J, Toll A, Pigem R, Garcia A, Alos LL, Puig S. Ex vivo confocal microscopy: revolution in fast pathology in dermatology. Br J Dermatol 2020; 183:1011-1025. [PMID: 32134506 DOI: 10.1111/bjd.19017] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
Confocal microscopy with in vivo and ex vivo modalities has been used in the evaluation of skin cancer and other dermatological disorders. Recent developments in ex vivo confocal microscopy allow for faster pathology assessment with greater accuracy by the visualization of cellular and architectural details, similarly to standard pathology, in either paraffin-embedded or frozen samples. They include the possibility of multimodal confocal microscopy using different lasers and fusion images. New staining protocols including immunostaining, with no damage to conventional histopathology preparation, have been recently described in melanocytic tumours and inflammatory skin diseases. Digital staining with haematoxylin and eosin is also incorporated in the new devices. In this review the applications of ex vivo confocal microscopy will be presented with the description of the technique and the technology, clinical evidence in dermatology and other fields, and further applications.
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Affiliation(s)
- J Malvehy
- Dermatology Department, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - J Pérez-Anker
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - A Toll
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - R Pigem
- Dermatology Department, University of Barcelona, Barcelona, Spain
| | - A Garcia
- Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - L L Alos
- Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology Department, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
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11
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Krishnamurthy S, Brown JQ, Iftimia N, Levenson RM, Rajadhyaksha M. Ex Vivo Microscopy: A Promising Next-Generation Digital Microscopy Tool for Surgical Pathology Practice. Arch Pathol Lab Med 2019; 143:1058-1068. [PMID: 31295016 PMCID: PMC7365575 DOI: 10.5858/arpa.2019-0058-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT.— The rapid evolution of optical imaging modalities in recent years has opened the opportunity for ex vivo tissue imaging, which has significant implications for surgical pathology practice. These modalities have promising potential to be used as next-generation digital microscopy tools for examination of fresh tissue, with or without labeling with contrast agents. OBJECTIVE.— To review the literature regarding various types of ex vivo optical imaging platforms that can generate digital images for tissue recognition with potential for utilization in anatomic pathology clinical practices. DATA SOURCES.— Literature relevant to ex vivo tissue imaging obtained from the PubMed database. CONCLUSIONS.— Ex vivo imaging of tissues can be performed by using various types of optical imaging techniques. These next-generation digital microscopy tools have a promising potential for utilization in surgical pathology practice.
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Affiliation(s)
- Savitri Krishnamurthy
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Jonathan Quincy Brown
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Nicusor Iftimia
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Richard M Levenson
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
| | - Milind Rajadhyaksha
- From the Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston (Dr Krishnamurthy); Biomedical Engineering, Tulane University, New Orleans, Louisiana (Dr Brown); Physical Sciences Inc, Andover, Massachusetts (Dr Iftimia); the Department of Pathology and Laboratory Medicine, University of California Davis, Davis (Dr Levenson); and Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rajadhyaksha)
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12
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Badash I, Shauly O, Lui CG, Gould DJ, Patel KM. Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619865278. [PMID: 31384136 PMCID: PMC6657122 DOI: 10.1177/1179550619865278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher G Lui
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Chang H, Jang WH, Lee S, Kim B, Kim MJ, Kim WO, Ryoo YW, Oh BH, Kim KH. Moxifloxacin Labeling-Based Multiphoton Microscopy of Skin Cancers in Asians. Lasers Surg Med 2019; 52:373-382. [PMID: 31338864 DOI: 10.1002/lsm.23138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Although multiphoton microscopy (MPM) can visualize both cell and extracellular matrix (ECM) structures of the skin in high-contrast without exogenous labeling, label-free MPM is usually too slow to image clinically relevant large regions. A high-speed MPM method would be beneficial for evaluating clinical skin specimens by increasing the imaging area. In this study, moxifloxacin labeling-based MPM (moxifloxacin MPM) was characterized in various human skin cancer specimens. STUDY DESIGN/MATERIALS AND METHODS Moxifloxacin ophthalmic solution was used for cell-labeling and MPM imaging was conducted afterwards. Moxifloxacin MPM was characterized in ex vivo normal human skin and skin cancer specimens in comparison with the label-free MPM and fluorescence confocal microscopy (FCM) using acridine orange as a labeling agent. Then, moxifloxacin MPM was applied to various ex vivo human skin cancer specimens including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), dermatofibrosarcoma protuberans (DFSP). Results of moxifloxacin MPM were compared with bright-field clinical and histopathologic findings. RESULTS Moxifloxacin MPM imaged both cells and collagen in the skin, similarly to label-free MPM, but with enhanced fluorescence intensities in cells and enhanced imaging speeds. Moxifloxacin MPM imaged cells in the skin similarly to acridine orange-based FCM. Moxifloxacin MPM of various human skin cancer specimens imaged their specific cellular features. The microscopic features detected in moxifloxacin MPM were confirmed with histological images. CONCLUSIONS This observational pilot study demonstrated that moxifloxacin MPM could detect specific cellular features of various skin cancers in good correlation with histopathological images in Asian patients at the higher imaging speed than label-free MPM. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Hoonchul Chang
- Division of Integrative Biosciences & Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk, 37673, Republic of Korea
| | - Won Hyuk Jang
- Division of Integrative Biosciences & Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk, 37673, Republic of Korea
| | - Seunghun Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk, 37673, Republic of Korea
| | - Bumju Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk, 37673, Republic of Korea
| | - Myoung Joon Kim
- Department of Ophthalmology, Asan Medical Center, Asan University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Won Oh Kim
- Department of Dermatology, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Young Wook Ryoo
- Department of Dermatology, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Byung Ho Oh
- Department of Dermatology, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ki Hean Kim
- Division of Integrative Biosciences & Biotechnology, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk, 37673, Republic of Korea.,Department of Mechanical Engineering, Pohang University of Science and Technology, 77 Cheongam-Ro, Nam-gu, Pohang, Gyeongbuk, 37673, Republic of Korea
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14
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Notingher I. Can fluorescence confocal microscopy replace frozen sections for margin assessment in Mohs micrographic surgery? Br J Dermatol 2019; 180:1295-1296. [PMID: 31157436 DOI: 10.1111/bjd.17735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- I Notingher
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, U.K
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15
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Sun CK, Kao CT, Wei ML, Chia SH, Kärtner FX, Ivanov A, Liao YH. Slide-free imaging of hematoxylin-eosin stained whole-mount tissues using combined third-harmonic generation and three-photon fluorescence microscopy. JOURNAL OF BIOPHOTONICS 2019; 12:e201800341. [PMID: 30636033 DOI: 10.1002/jbio.201800341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/15/2018] [Accepted: 01/09/2019] [Indexed: 05/24/2023]
Abstract
Intraoperative margin assessment of surgical tissues during cancer surgery is clinically important, especially in the case of tissue conserving surgery like Mohs micrographic surgery in which minimization of the surgical area is considered crucial. Frozen pathology is the gold standard of assessing excised tissues for signs of remaining cancerous lesions. The current protocol, however, is time-consuming and labor-intensive. Instead of the complex frozen sectioning, staining, and traditional white light microscopy imaging protocol, optically sectioned histopathological imaging of hematoxylin-eosin stained whole-mount skin tissues with a subfemtoliter resolution is demonstrated by using nonlinear microscopy in this study. With our proposed method, the reagents of staining and the contrast of imaging are fully consistent with the current clinical standard of frozen pathology, thus facilitating rapid intraoperative assessment of surgical tissues for future applications. Image: Slide-free nonlinear microscopy imaging of H&E stained whole-mount skin tissue showing the morphology of sweat glands.
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Affiliation(s)
- Chi-Kuang Sun
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
- Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chien-Ting Kao
- Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ming-Liang Wei
- Graduate Institute of Photonics and Optoelectronics and Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
- Molecular Imaging Center and Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Shih-Hsuan Chia
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
- Physics Department, University of Hamburg and the Hamburg Center for Ultrafast Imaging, Hamburg, Germany
| | - Franz X Kärtner
- Center for Free-Electron Laser Science, Deutsches Elektronen-Synchrotron, Hamburg, Germany
- Physics Department, University of Hamburg and the Hamburg Center for Ultrafast Imaging, Hamburg, Germany
| | - Anatoly Ivanov
- Federal Scientific Research Center of Crystallography and Photonics, Russian Academy of Sciences, Moscow, Russia
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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16
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Longo C, Pampena R, Bombonato C, Gardini S, Piana S, Mirra M, Raucci M, Kyrgidis A, Pellacani G, Ragazzi M. Diagnostic accuracy of ex vivo fluorescence confocal microscopy in Mohs surgery of basal cell carcinomas: a prospective study on 753 margins. Br J Dermatol 2019; 180:1473-1480. [PMID: 30512198 DOI: 10.1111/bjd.17507] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Frozen histological sections are used for intraoperative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool that offers a promising and faster alternative to frozen histology. OBJECTIVES To evaluate prospectively in a clinical setting the accuracy of FCM vs. frozen sections in margin assessment of basal cell carcinoma (BCC). METHODS Patients with BCC scheduled for Mohs surgery were prospectively enrolled. Freshly excised surgical specimens were examined by FCM and then frozen sections were evaluated. Permanent sections were obtained, in order to validate the sample technique. A blind re-evaluation was also performed for discordant cases. Sensitivity and specificity levels, as well as positive and negative predictive values (PPV and NPV, respectively), were calculated and receiver-operating characteristic curves generated. RESULTS We enrolled 127 BCCs in as many patients (40·2% females). Seven hundred and fifty-three sections were examined. All BCCs were located in the head and neck area. In evaluating the performance of FCM vs. frozen sections, sensitivity was 79·8%, specificity was 95·8%, PPV was 80·5% and NPV was 95·7% [area under the curve 0·88, 95% confidence interval 0·84-0·92 (P < 0·001)]. Forty-nine discordant cases were re-evaluated; 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment. CONCLUSIONS We found high levels of accuracy for FCM vs. frozen section evaluation in intraoperative BCC margin assessment during Mohs surgery. Some technical issues prevent the wide use of this technique, but new devices promise to overcome these limitations.
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Affiliation(s)
- C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - R Pampena
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - C Bombonato
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - S Gardini
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - S Piana
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - M Mirra
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - M Raucci
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - A Kyrgidis
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
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17
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Schneider SL, Kohli I, Hamzavi IH, Council ML, Rossi AM, Ozog DM. Emerging imaging technologies in dermatology: Part II: Applications and limitations. J Am Acad Dermatol 2018; 80:1121-1131. [PMID: 30528310 DOI: 10.1016/j.jaad.2018.11.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
Clinical examination is critical for the diagnosis and identification of response to treatment. It is fortunate that technologies are continuing to evolve, enabling augmentation of classical clinical examination with noninvasive imaging modalities. This article discusses emerging technologies with a focus on digital photographic imaging, confocal microscopy, optical coherence tomography, and high-frequency ultrasound, as well as several additional developing modalities. The most readily adopted technologies to date include total-body digital photography and dermoscopy, with some practitioners beginning to use confocal microscopy. In this article, applications and limitations are addressed. For a detailed discussion of the principles involved in these technologies, please refer to the first part of this review article.
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Affiliation(s)
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - M Laurin Council
- Division of Dermatology, Washington University, St. Louis, Missouri
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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18
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Schneider SL, Kohli I, Hamzavi IH, Council ML, Rossi AM, Ozog DM. Emerging imaging technologies in dermatology: Part I: Basic principles. J Am Acad Dermatol 2018; 80:1114-1120. [PMID: 30528311 DOI: 10.1016/j.jaad.2018.11.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022]
Abstract
Dermatologists rely primarily on clinical examination in combination with histopathology to diagnose conditions; however, clinical examination alone might not be sufficient for accurate diagnosis and skin biopsies have associated morbidity. With continued technological advancement, there are emerging ancillary imaging technologies available to dermatologists to aid in diagnosis and management. This 2-part review article will discuss these emerging technologies including: digital photographic imaging, confocal microscopy, optical coherence tomography, and high-frequency ultrasound, as well as several additional modalities in development. In this first installment, the authors describe the breadth of technologies available and the science behind them. Then, in the second article, the authors discuss the applications and limitations of these technologies and future directions.
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Affiliation(s)
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - M Laurin Council
- Division of Dermatology, Washington University, St. Louis, Missouri
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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19
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Kang J, Song I, Kim H, Kim H, Lee S, Choi Y, Chang HJ, Sohn DK, Yoo H. Rapid tissue histology using multichannel confocal fluorescence microscopy with focus tracking. Quant Imaging Med Surg 2018; 8:884-893. [PMID: 30505717 PMCID: PMC6218212 DOI: 10.21037/qims.2018.09.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Simplified hematoxylin and eosin (H&E) staining followed by cryo-sectioning enables rapid identification of cancerous tissue within the procedure room during Mohs micrographic surgery. Yet, a faster evaluation method is desirable as the staining protocol requires physically sectioning of the tissue after freezing, which leads to prolonged sectioning time along with the frozen artifacts that may occur in frozen sectioning. METHODS We present a multichannel confocal microscopy system to rapidly evaluate cancerous tissue. Using the optical sectioning capability of the confocal microscope, optically sectioned images of the freshly excised mouse tissue were acquired and converted into images resembling H&E histology. To show details of the nuclei and structure of the tissue, we applied a newly developed rapid tissue staining method using Hoechst 33342 and Eosin-Y. Line scanning and stitching was performed to overcome the limited field of view of the confocal microscope. Unlike previous confocal systems requiring an additional mechanical device to tilt the sample and match the focus of the objective lens, we developed a focus tracking method to rapidly scan large sample area. The focus tracking provides an effective means of keeping the image of the thick tissue in focus without additional devices. We then evaluated the performance of the confocal microscope to obtain optically sectioned images in thick tissue by comparing fluorescence stained slide images. We also obtained the corresponding H&E histology image to assess the potential of the system as a diagnostic tool. RESULTS We successfully imaged freshly excised mouse organs including stomach, tumor, and heart within a few minutes using the developed multichannel confocal microscopy and the tissue staining method. Using the pseudocolor method, colors of the acquired confocal grayscale images are converted to furthermore resemble Hematoxylin and Eosin histology. Due to the focus tracking and the line scanning, optically sectioned images were obtained over the large field of view. Comparisons with H&E histology have shown that the confocal images can acquire large details such as the ventricle as well as small details such as muscle fibers and nuclei. CONCLUSIONS This study confirms the use of confocal fluorescence microscopy technique to acquire rapid pathology results using optical sectioning, line scanning and focus tracking. We anticipate that the presented method will enable intraoperative histology and significantly reduce stress on patients undergoing surgery requiring repeated histology examinations.
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Affiliation(s)
- Juehyung Kang
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Incheon Song
- Nanoscope Systems Inc., Daejeon, Republic of Korea
| | - Hongrae Kim
- Department of Biomedical Engineering, National Cancer Center, Goyang, Republic of Korea
| | - Hyunjin Kim
- Biomarker Branch, National Cancer Center, Goyang, Republic of Korea
| | - Sunhye Lee
- Department of Biomedical Engineering, National Cancer Center, Goyang, Republic of Korea
| | - Yongdoo Choi
- Biomarker Branch, National Cancer Center, Goyang, Republic of Korea
| | - Hee Jin Chang
- Center of Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Department of Biomedical Engineering, National Cancer Center, Goyang, Republic of Korea
- Center of Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hongki Yoo
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
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20
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Teixeira DA, Rezze GG, Pinhal MAS, Paschoal FM. Reflectance confocal microscopy as a tool for screening surgical margins of basal cell carcinoma. An Bras Dermatol 2018; 93:601-604. [PMID: 30066778 PMCID: PMC6063104 DOI: 10.1590/abd1806-4841.20187089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/29/2017] [Indexed: 11/22/2022] Open
Abstract
Surgical excision of basal cell carcinoma with minimum margins requires serial assessment of layers by frozen histopathology in the case of Mohs micrographic surgery. Evaluation of presurgical tumor margins by in vivo reflectance confocal microscopy is a potential alternative. We selected 12 basal cell carcinoma lesions that were analyzed by confocal microscopy to define margins. The lesions were excised by Mohs surgery. Six tumors showed negative margins in the first phase of Mohs micrographic surgery. We concluded that reflectance confocal microscopy can be useful in the preoperative definition of basal cell carcinoma margins.
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Affiliation(s)
- Danilo Augusto Teixeira
- Graduate Master's Program in Health Sciences, Faculdade de Medicina do ABC, Santo André (SP), Brazil
- Outpatient Clinic for Dermatological Surgery of the Medical Residency Program, Hospital de Doenças Tropicais, Goiânia (GO), Brazil
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21
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Salmivuori M, Neittaanmäki N, Pölönen I, Jeskanen L, Snellman E, Grönroos M. Hyperspectral imaging system in the delineation of Ill-defined basal cell carcinomas: a pilot study. J Eur Acad Dermatol Venereol 2018; 33:71-78. [PMID: 29846972 DOI: 10.1111/jdv.15102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/23/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer in the Caucasian population. Eighty per cent of BCCs are located on the head and neck area. Clinically ill-defined BCCs often represent histologically aggressive subtypes, and they can have subtle subclinical extensions leading to recurrence and the need for re-excisions. OBJECTIVES The aim of this pilot study was to test the feasibility of a hyperspectral imaging system (HIS) in vivo in delineating the preoperatively lateral margins of ill-defined BCCs on the head and neck area. METHODS Ill-defined BCCs were assessed clinically with a dermatoscope, photographed and imaged with HIS. This was followed by surgical procedures where the BCCs were excised at the clinical border and the marginal strip separately. HIS, with a 12-cm2 field of view and fast data processing, records a hyperspectral graph for every pixel in the imaged area, thus creating a data cube. With automated computational modelling, the spectral data are converted into localization maps showing the tumour borders. Interpretation of these maps was compared to the histologically verified tumour borders. RESULTS Sixteen BCCs were included. Of these cases, 10 of 16 were the aggressive subtype of BCC and 6 of 16 were nodular, superficial or a mixed type. HIS delineated the lesions more accurately in 12 of 16 of the BCCs compared to the clinical evaluation (4 of 16 wider and 8 of 16 smaller by HIS). In 2 of 16 cases, the HIS-delineated lesion was wider without histopathological confirmation. In 2 of 16 cases, HIS did not detect the histopathologically confirmed subclinical extension. CONCLUSIONS HIS has the potential to be an easy and fast aid in the preoperative delineation of ill-defined BCCs, but further adjustment and larger studies are warranted for an optimal outcome.
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Affiliation(s)
- M Salmivuori
- Department of Dermatology and Allergology, Joint Authority for Päijät-Häme Health and Wellbeing, Lahti, Finland.,Department of Dermatology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - N Neittaanmäki
- Departments of Pathology and Dermatology, Institutes of Biomedicine and Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Pölönen
- Faculty of Mathematical Information Technology, University of Jyväskylä, Jyväskylä, Finland
| | - L Jeskanen
- Department of Dermatology and Allergology, Helsinki University Central Hospital, Helsinki, Finland
| | - E Snellman
- Department of Dermatology and Allergology, Joint Authority for Päijät-Häme Health and Wellbeing, Lahti, Finland.,Department of Dermatology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - M Grönroos
- Department of Dermatology and Allergology, Joint Authority for Päijät-Häme Health and Wellbeing, Lahti, Finland
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22
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Longo C, Borsari S, Pampena R, Benati E, Bombonato C, Raucci M, Mirra M, Di Stefani A, Peris K, Pellacani G. Basal cell carcinoma: the utility of in vivo
and ex vivo
confocal microscopy. J Eur Acad Dermatol Venereol 2018; 32:2090-2096. [DOI: 10.1111/jdv.14984] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- C. Longo
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | - S. Borsari
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | - R. Pampena
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | - E. Benati
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | - C. Bombonato
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | - M. Raucci
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | - M. Mirra
- Centro Oncologico ad Alta Teconologia Diagnostica; Azienda Unità Sanitaria Locale; IRCCS Reggio Emilia Italy
| | | | - K. Peris
- Dermatology Unit; Catholic University; Rome Italy
| | - G. Pellacani
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
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23
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Cinotti E, Perrot JL, Labeille B, Cambazard F, Rubegni P. Ex vivo confocal microscopy: an emerging technique in dermatology. Dermatol Pract Concept 2018; 8:109-119. [PMID: 29785327 PMCID: PMC5955077 DOI: 10.5826/dpc.0802a08] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/18/2018] [Indexed: 12/13/2022] Open
Abstract
This review aims to give an overview of the current available applications of ex vivo confocal microscopy (EVCM) in dermatology. EVCM is a relatively new imaging technique that allows microscopic examination of freshly excised unfixed tissue. It enables a rapid examination of the skin sample directly in the surgery room and thus represents an alternative to the intraoperative micrographic control of the surgical margins of cutaneous tumors by standard microscopic examination on cryopreserved sections during Mohs surgery. Although this technique has mainly been developed for the margin’s control of basal cell carcinoma, many other skin tumors have been studied, including melanoma. Use of EVCM is continuing to evolve, and many possible applications are under investigation, such as the study of nails and hair diseases and the diagnosis of skin infections.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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24
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Abstract
Confocal microscopy is a modern imaging device that has been extensively applied in skin oncology. More specifically, for tumor margin assessment, it has been used in two modalities: reflectance mode (in vivo on skin patient) and fluorescence mode (on freshly excised specimen). Although in vivo reflectance confocal microscopy is an add-on tool for lentigo maligna mapping, fluorescence confocal microscopy is far superior for basal cell carcinoma and squamous cell carcinoma margin assessment in the Mohs setting. This article provides a comprehensive overview of the use of confocal microscopy for skin cancer margin evaluation.
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25
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Hartmann D, Ruini C, Mathemeier L, Bachmann MR, Dietrich A, Ruzicka T, von Braunmühl T. Identification of ex-vivo confocal laser scanning microscopic features of melanocytic lesions and their histological correlates. JOURNAL OF BIOPHOTONICS 2017; 10:128-142. [PMID: 27091702 DOI: 10.1002/jbio.201500335] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 06/05/2023]
Abstract
Ex-vivo confocal laser scanning microscopy (CLSM) offers rapid tissue examination. Current literature shows promising results in the evaluation of non-melanoma skin cancer but little is known about presentation of melanocytic lesions (ML). This study evaluates ML with ex-vivo CLSM in comparison to histology and offers an overview of ex-vivo CLSM characteristics. 31 ML were stained with acridine orange or fluorescein and examined using ex-vivo CLSM (Vivascope2500® ; Lucid Inc; Rochester NY) in reflectance and fluorescence mode. Confocal images were correlated to histopathology. Benign and malignant features of the ML were listed and results were presented. Sensitivity and specificity were calculated using contingency tables. The ML included junctional, compound, dermal, Spitz and dysplastic nevi, as well as various melanoma subtypes. The correlation of the confocal findings with histopathology allowed the identification of different types of ML and differentiation of benign and malignant features. The study offers an overview of confocal characteristics of ML in comparison to histology. Ex-vivo CLSM does not reproduce the typical in-vivo horizontal mosaics but rather reflects the vertical histological presentation. Not all typical in-vivo patterns are detectable here. These findings may help to evaluate the ex-vivo CLSM as an adjunctive tool in the immediate intraoperative diagnosis of ML. Superficial spreading malignant melanoma. Histopathology (H&E stain; 200×) correlated to the reflectance (RM; 830 nm) and fluorescence mode (FM; 488 nm) in the ex-vivo CLSM (Vivablock® by VivaScan® , acridine orange).
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Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Cristel Ruini
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Mario Raphael Bachmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Andreas Dietrich
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
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26
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27
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Hartmann D, Ruini C, Mathemeier L, Dietrich A, Ruzicka T, von Braunmühl T. Identification of ex-vivo confocal scanning microscopic features and their histological correlates in human skin. JOURNAL OF BIOPHOTONICS 2016; 9:376-387. [PMID: 25996548 DOI: 10.1002/jbio.201500124] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
Ex-vivo confocal laser scanning microscopy (CLSM) is an emerging diagnostic tool allowing fast and easy microscopic tissue examination. The first generation of ex-vivo devices have already shown promising results in the ex-vivo evaluation of basal cell carcinoma compared to Mohs surgery. Nevertheless, for the diagnostics of pathological skin lesions the knowledge of normal skin features is essential. Therefore we examined 50 samples of healthy skin from various donor sites including head and neck (n = 25), trunk (n = 10), upper (n = 10) and lower extremities (n = 5) using a new generation ex-vivo CLSM device offering three different laser wavelengths and compared the findings to the corresponding histological sections. In correlation with the histopathology we identified different layers of the epidermis, differentiated keratinocytes from melanocytes and described in detail skin appendages including hair follicle, sebaceous and sweat glands. Furthermore, structures of the dermis and subcutis were illustrated. Additionally, artefacts and pitfalls occurring with the use of ex-vivo CLSM have been documented. The study offers an overview of the main ex-vivo CLSM skin characteristics in comparison to the standard histological examination and helps to recognize and avoid common artefacts. Anatomy of a hair follicle in the reflectance mode (RM) CLSM, fluorescence mode (FM) CLSM and in a routine hematoxylin-eosin stained histological section (H).
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Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
| | - Cristel Ruini
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Andreas Dietrich
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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28
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Rossi AM, Sierra H, Rajadhyaksha M, Nehal K. Novel approaches to imaging basal cell carcinoma. Future Oncol 2015; 11:3039-46. [PMID: 26467205 DOI: 10.2217/fon.15.231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The gold standard of diagnosis for nonmelanoma and melanoma skin cancer has been skin biopsy with routine paraffin embedded hematoxylin and eosin histopathology. This practice is frequently carried out on suspicious lesions to rule out a malignant process. Therefore, as a result, many biopsies are done on benign lesions. Unlike other fields of medicine that rely on noninvasive imaging modalities, the use of imaging devices in dermatology has not been as robust. This has been mainly due to the limited resolution offered by imaging devices that is needed to detect malignant changes in the cutaneous layers. However, the demand for more efficient in vivo and ex vivo imaging tools to reduce the amount of biopsies have led to new areas of investigation using noninvasive modalities to augment the clinical diagnosis of skin cancer. The use of noninvasive imaging both in vivo and ex vivo has the potential to increase efficiency of diagnosis and management, decrease healthcare cost, improve clinical care and enhance patient satisfaction.
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Affiliation(s)
- Anthony M Rossi
- Memorial Sloan Kettering Cancer Center, Dermatology Service, 160 East 53rd Street, 2nd Floor, New York, NY 10022, USA
| | - Heidy Sierra
- Memorial Sloan Kettering Cancer Center, Dermatology Service, 160 East 53rd Street, 2nd Floor, New York, NY 10022, USA
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, 160 East 53rd Street, 2nd Floor, New York, NY 10022, USA
| | - Kiswher Nehal
- Memorial Sloan Kettering Cancer Center, Dermatology Service, 160 East 53rd Street, 2nd Floor, New York, NY 10022, USA
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29
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Que SKT, Fraga-Braghiroli N, Grant-Kels JM, Rabinovitz HS, Oliviero M, Scope A. Through the looking glass: Basics and principles of reflectance confocal microscopy. J Am Acad Dermatol 2015; 73:276-84. [PMID: 26051696 DOI: 10.1016/j.jaad.2015.04.047] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/13/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
Abstract
Reflectance confocal microscopy (RCM) offers high-resolution, noninvasive skin imaging and can help avoid obtaining unnecessary biopsy specimens. It can also increase efficiency in the surgical setting by helping to delineate tumor margins. Diagnostic criteria and several RCM algorithms have been published for the differentiation of benign and malignant neoplasms. We provide an overview of the basic principles of RCM, characteristic RCM features of normal skin and cutaneous neoplasms, and the limitations and future directions of RCM.
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Affiliation(s)
- Syril Keena T Que
- Department of Dermatology at the University of Connecticut Health Center, Farmington, Connecticut.
| | | | - Jane M Grant-Kels
- Department of Dermatology at the University of Connecticut Health Center, Farmington, Connecticut
| | - Harold S Rabinovitz
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret Oliviero
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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30
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Flores ES, Cordova M, Kose K, Phillips W, Rossi A, Nehal K, Rajadhyaksha M. Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: initial clinical experience. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:61103. [PMID: 25706821 PMCID: PMC4405085 DOI: 10.1117/1.jbo.20.6.061103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/04/2014] [Indexed: 05/22/2023]
Abstract
Mohs surgery for the removal of nonmelanoma skin cancers (NMSCs) is performed in stages, while being guided by the examination for residual tumor with frozen pathology. However, preparation of frozen pathology at each stage is time consuming and labor intensive. Real-time intraoperative reflectance confocal microscopy(RCM), combined with video mosaicking, may enable rapid detection of residual tumor directly in the surgical wounds on patients. We report our initial experience on 25 patients, using aluminum chloride for nuclear contrast. Imaging was performed in quadrants in the wound to simulate the Mohs surgeon’s examination of pathology. Images and videos of the epidermal and dermal margins were found to be of clinically acceptable quality. Bright nuclear morphology was identified at the epidermal margin and detectable in residual NMSC tumors. The presence of residual tumor and normal skin features could be detected in the peripheral and deep dermal margins. Intraoperative RCM imaging may enable detection of residual tumor directly on patients during Mohs surgery, and may serve as an adjunct for frozen pathology. Ultimately, for routine clinical utility, a stronger tumor-to-dermis contrast may be necessary, and also a smaller microscope with an automated approach for imaging in the entire wound in a rapid and controlled manner.
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Affiliation(s)
- Eileen S. Flores
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
- *Address all correspondence to: Eileen S. Flores, E-mail:
| | - Miguel Cordova
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
| | - Kivanc Kose
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
| | - William Phillips
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
| | - Anthony Rossi
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
| | - Kishwer Nehal
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York 10022, United States
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31
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Kose K, Cordova M, Duffy M, Flores ES, Brooks DH, Rajadhyaksha M. Video-mosaicing of reflectance confocal images for examination of extended areas of skin in vivo. Br J Dermatol 2014; 171:1239-41. [PMID: 24720744 DOI: 10.1111/bjd.13050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- K Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A.
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