1
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Hren R, Sersa G, Simoncic U, Milanic M. Imaging microvascular changes in nonocular oncological clinical applications by optical coherence tomography angiography: a literature review. Radiol Oncol 2023; 57:411-418. [PMID: 38038417 PMCID: PMC10690745 DOI: 10.2478/raon-2023-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is an emerging imaging modality that enables noninvasive visualization and analysis of tumor vasculature. OCTA has been particularly useful in clinical ocular oncology, while in this article, we evaluated OCTA in assessing microvascular changes in clinical nonocular oncology through a systematic review of the literature. METHOD The inclusion criterion for the literature search in PubMed, Web of Science and Scopus electronic databases was the use of OCTA in nonocular clinical oncology, meaning that all ocular clinical studies and all ocular and nonocular animal, phantom, ex vivo, experimental, research and development, and purely methodological studies were excluded. RESULTS Eleven articles met the inclusion criteria. The anatomic locations of the neoplasms in the selected articles were the gastrointestinal tract (2 articles), head and neck (1 article) and skin (8 articles). CONCLUSIONS While OCTA has shown great advancements in ophthalmology, its translation to the nonocular clinical oncology setting presents several limitations, with a lack of standardized protocols and interpretation guidelines posing the most significant challenge.
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Affiliation(s)
- Rok Hren
- Faculty of Mathematics and Physics, Ljubljana, Slovenia
- Institute of Mathematics, Physics, and Mechanics, Ljubljana, Slovenia
- Syreon Research Institute, Budapest, Hungary
| | - Gregor Sersa
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Urban Simoncic
- Faculty of Mathematics and Physics, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
| | - Matija Milanic
- Faculty of Mathematics and Physics, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
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2
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Ud-Din S, Bayat A. Noninvasive Objective Tools for Quantitative Assessment of Skin Scarring. Adv Wound Care (New Rochelle) 2022; 11:132-149. [PMID: 33966482 DOI: 10.1089/wound.2020.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Significance: Many treatments are utilized in the management of skin scarring; however, difficulties arise due to the high rates of recurrence and the identification of treatment efficacy in each patient, in particular, in the case of raised dermal scarring. Therefore, evaluation of treatments and the provision of objective scar assessment pre-therapy and post-therapy is of paramount importance to identify changes in scar characteristics using noninvasive devices. Recent Advances: There have been a number of emerging noninvasive objective quantitative devices, which assess specific scar parameters such as pliability, volume, color, perfusion, and depth. These can include three-dimensional imaging, optical coherence tomography, in vivo confocal microscopy, full-field laser perfusion imaging, and spectrophotometric intracutaneous analysis. Critical Issues: Clinical assessment and grading scales are most commonly used to assess scarring; however, there is a need for more objective quantitative measures to monitor their maturation and response to therapy. Currently, there is no consensus as to which objective measuring device is most optimal when assessing skin scarring. There is a need for a predictor tool that allows early implementation of treatment and addresses diagnosis, therapy, and prognosis. Future Directions: Validation of noninvasive objective scar assessment tools is essential as well as further development of technologies. There are currently more modalities that assess physical scar characteristics and only few that measure the physiological parameters. Therefore, the development of a technology that quantifies the metabolic and cellular activity in skin scars is necessary to allow for bespoke strategies for each patient.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
- MRC-SA Wound Healing Unit, Division of Dermatology, University of Cape Town, Cape Town, South Africa
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3
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A comparative study of features selection for skin lesion detection from dermoscopic images. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s13721-019-0209-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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4
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Wang L, Boussetta N, Lebovka N, Lefebvre C, Vorobiev E. Correlations between disintegration degree of fruit skin cells induced by ultrasound and efficiency of bio-compounds extraction. ULTRASONICS SONOCHEMISTRY 2019; 52:280-285. [PMID: 30555040 DOI: 10.1016/j.ultsonch.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/18/2018] [Accepted: 11/30/2018] [Indexed: 06/09/2023]
Abstract
The ultrasound (US) assisted extraction of bio-compounds from different fruit skins (apples, bananas and persimmons) was studied. The aqueous suspensions of skins were treated by US with different energy inputs (0.033-0.299 kW·h/kg) and total time of aqueous extraction was up to 2700 s. The ionic, Zi, and total polyphenol, Zp, extraction indexes of the liquid extracts were analyzed. From microscopic images the cell wall disintegration index, Zm, was determined. Increase in US energy input caused the increase of values of Zi, Zp and Zm. The correlations between extraction parameters and the disintegration index, Zm, were discussed.
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Affiliation(s)
- Lu Wang
- Sorbonne Universités, Université de Technologie de Compiègne, Laboratoire de Transformations Intégrées de la Matière Renouvelable, EA 4297, Centre de Recherches de Royallieu, BP 20529, 60205 Compiègne Cedex, France
| | - Nadia Boussetta
- Sorbonne Universités, Université de Technologie de Compiègne, Laboratoire de Transformations Intégrées de la Matière Renouvelable, EA 4297, Centre de Recherches de Royallieu, BP 20529, 60205 Compiègne Cedex, France.
| | - Nikolai Lebovka
- Sorbonne Universités, Université de Technologie de Compiègne, Laboratoire de Transformations Intégrées de la Matière Renouvelable, EA 4297, Centre de Recherches de Royallieu, BP 20529, 60205 Compiègne Cedex, France; Institute of Biocolloidal Chemistry named after F. D. Ovcharenko, NAS of Ukraine, 42, blvr. Vernadskogo, Kyiv 03142, Ukraine
| | - Caroline Lefebvre
- Sorbonne Universités, Université de Technologie de Compiègne, Service d'Analyse Physico-Chimique, Centre de Recherches de Royallieu, BP 20529, 60205 Compiègne Cedex, France
| | - Eugène Vorobiev
- Sorbonne Universités, Université de Technologie de Compiègne, Laboratoire de Transformations Intégrées de la Matière Renouvelable, EA 4297, Centre de Recherches de Royallieu, BP 20529, 60205 Compiègne Cedex, France
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5
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Wortman TD, Carlson JD, Perez E, Slocum AH. LesionAir: An Automated, Low-Cost Vision-Based Skin Cancer Diagnostic Tool. J Med Device 2018. [DOI: 10.1115/1.4039209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Current techniques for diagnosing skin cancer lack specificity and sensitivity, resulting in unnecessary biopsies and missed diagnoses. Automating tissue palpation and morphology quantification will result in a repeatable, objective process. LesionAir is a low-cost skin cancer diagnostic tool that measures the full-field compliance of tissue by applying a vacuum force and measuring the precise deflection using structured light three-dimensional (3D) reconstruction. The technology was tested in a benchtop setting on phantom skin and in a small clinical study. LesionAir has been shown to measure deflection with a 0.085 mm root-mean-square (RMS) error and measured the stiffness of phantom tissue to within 20% of finite element analysis (FEA) predictions. After biopsy and analysis, a dermatopathologist confirmed the diagnosis of skin cancer in tissue that LesionAir identified as noticeably stiffer and the regions of this stiffer tissue aligned with the bounds of the lesion. A longitudinal, full-scale study is required to determine the clinical efficacy of the device. This technology shows initial promise as a low-cost tool that could rapidly identify and diagnose skin cancer.
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Affiliation(s)
- Tyler D. Wortman
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139 e-mail:
| | - Jay D. Carlson
- Department of Electrical Engineering, University of Nebraska-Lincoln, 209N SEC, 844 N. 16th Street, Lincoln, NE 68588 e-mail:
| | - Edward Perez
- Dermatology Laser Center, 1605 Redwood Road, San Marcos, TX 78666 e-mail:
| | - Alexander H. Slocum
- Fellow ASME Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139 e-mail:
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6
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Saral S, Hartmann D, Letulè V, Ruzicka T, Ruini C, von Braunmühl T. "Twin lesions": Which one is the bad one? Improvement of clinical diagnosis with reflectance confocal microscopy. Dermatol Pract Concept 2017; 7:11-17. [PMID: 28243488 PMCID: PMC5315034 DOI: 10.5826/dpc.0701a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/22/2016] [Indexed: 12/02/2022] Open
Abstract
Background In vivo reflectance confocal microscopy (RCM) is a novel non-invasive diagnostic tool, which is used to differentiate skin lesions. Even in lesions with similar dermatoscopic images, RCM may improve diagnostic accuracy. Methods Three sets of false “twin lesions” with similar macroscopic and dermatoscopic images are matched. All lesions are evaluated with RCM and lesions are excised for further evaluation. Corresponding features in confocal images, dermatoscopy and histopathology are discussed. Results In all matched pairs, one of the lesions was diagnosed as melanoma with the observation of melanoma findings such as: epidermal disarray, pagetoid cells in epidermis and cellular atypia at the junction. Benign lesions were differentiated easily with RCM imaging. Conclusion Examining dermatoscopically difficult and/or similar lesions with RCM facilitates diagnostic and therapeutic decision making. Using RCM in daily practice may contribute to a decrease in unnecessary excisions.
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Affiliation(s)
- Secil Saral
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Department of Dermatology and Venereology, Ankara University, Ankara, Turkey
| | - Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
| | - Valerie Letulè
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Cristel Ruini
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
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7
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Greveling K, van der Klok T, van Doorn MBA, Noordhoek Hegt V, Prens EP. Lentigo maligna - anatomic location as a potential risk factor for recurrences after non-surgical treatment. J Eur Acad Dermatol Venereol 2016; 31:450-454. [PMID: 27557425 PMCID: PMC5363235 DOI: 10.1111/jdv.13941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
Abstract
Background A higher incidence of lentigo maligna (LM) recurrences on the nose was previously observed in our cohort after non‐surgical treatment. Objectives To determine histological parameters that might be related to the previously observed higher incidence of LM recurrences on the nose after non‐surgical treatment. Methods We randomly selected 22 surgical specimens of LM on the nose and 22 on the cheek. Histopathological analysis was performed on haematoxylin and eosin stained and microphthalmia transcription factor immunohistochemically stained slides. The number of pilosebaceous units (PSU) per mm, maximum depth of atypical melanocytes along the skin appendages and maximum depth of the PSU itself were determined. Results The nose had a significantly higher density of PSU than the cheek. The atypical melanocytes extended deeper along the PSU on the nose with a mean (SD) depth of 1.29 mm (0.48) vs. a mean depth of 0.72 mm (0.30) on the cheek (P < 0.001). The maximum depth of the PSU on the nose was greater than on the cheek, mean (SD) depth of 2.28 mm (0.41) vs. 1.65 mm (0.82) (P = 0.003). Conclusions The higher recurrence risk of LM on the nose after non‐surgical treatment that we previously observed in our cohort is most likely based on a higher density of atypical melanocytes and also their deeper extension into the follicles. These results shed more light on our previous findings and learn that anatomical location is relevant for the risk of recurrence of LM after non‐surgical treatment.
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Affiliation(s)
- K Greveling
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Th van der Klok
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V Noordhoek Hegt
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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Weng WH, Liao YH, Tsai MR, Wei ML, Huang HY, Sun CK. Differentiating intratumoral melanocytes from Langerhans cells in nonmelanocytic pigmented skin tumors in vivo by label-free third-harmonic generation microscopy. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:76009. [PMID: 27424606 DOI: 10.1117/1.jbo.21.7.076009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/20/2016] [Indexed: 05/08/2023]
Abstract
Morphology and distribution of melanocytes are critical imaging information for the diagnosis of melanocytic lesions. However, how to image intratumoral melanocytes noninvasively in pigmented skin tumors is seldom investigated. Third-harmonic generation (THG) is shown to be enhanced by melanin, whereas high accuracy has been demonstrated using THG microscopy for in vivo differential diagnosis of nonmelanocytic pigmented skin tumors. It is thus desirable to investigate if label-free THG microscopy was capable to in vivo identify intratumoral melanocytes. In this study, histopathological correlations of label-free THG images with the immunohistochemical images stained with human melanoma black (HMB)-45 and cluster of differentiation 1a (CD1a) were made. The correlation results indicated that the intratumoral THG-bright dendritic-cell-like signals were endogenously derived from melanocytes rather than Langerhans cells (LCs). The consistency between THG-bright dendritic-cell-like signals and HMB-45 melanocyte staining showed a kappa coefficient of 0.807, 84.6% sensitivity, and 95% specificity. In contrast, a kappa coefficient of −0.37, 21.7% sensitivity, and 30% specificity were noted between the THG-bright dendritic-cell-like signals and CD1a staining for LCs. Our study indicates the capability of noninvasive label-free THG microscopy to differentiate intratumoral melanocytes from LCs, which is not feasible in previous in vivo label-free clinical-imaging modalities.
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Affiliation(s)
- Wei-Hung Weng
- National Taiwan University, Molecular Imaging Center, No. 1, Section 4, Roosevelt Road, Da'an District, Taipei 10617, TaiwanbHarvard Medical School, Department of Biomedical Informatics, 10 Shattuck Street, Boston, Massachusetts 02115, United States
| | - Yi-Hua Liao
- National Taiwan University, Molecular Imaging Center, No. 1, Section 4, Roosevelt Road, Da'an District, Taipei 10617, TaiwancNational Taiwan University Hospital and National Taiwan University College of Medicine, Department of Dermatology, No. 7, Zhongsha
| | - Ming-Rung Tsai
- National Taiwan University, Molecular Imaging Center, No. 1, Section 4, Roosevelt Road, Da'an District, Taipei 10617, Taiwan
| | - Ming-Liang Wei
- National Taiwan University, Molecular Imaging Center, No. 1, Section 4, Roosevelt Road, Da'an District, Taipei 10617, Taiwan
| | - Hsin-Yi Huang
- National Taiwan University Hospital and National Taiwan University College of Medicine, Department of Pathology, No. 7, Zhongshan S Road, Zhongzheng District, Taipei 100, Taiwan
| | - Chi-Kuang Sun
- National Taiwan University, Molecular Imaging Center, No. 1, Section 4, Roosevelt Road, Da'an District, Taipei 10617, TaiwaneNational Taiwan University, Department of Electrical Engineering and Graduate Institute of Photonics and Optoelectronics, No. 1, S
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9
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Ud-Din S, Bayat A. Non-invasive objective devices for monitoring the inflammatory, proliferative and remodelling phases of cutaneous wound healing and skin scarring. Exp Dermatol 2016; 25:579-85. [DOI: 10.1111/exd.13027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- University Hospital of South Manchester NHS Foundation Trust; Faculty of Medical and Human Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- University Hospital of South Manchester NHS Foundation Trust; Faculty of Medical and Human Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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10
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Xiong YD, Ma S, Li X, Zhong X, Duan C, Chen Q. A meta-analysis of reflectance confocal microscopy for the diagnosis of malignant skin tumours. J Eur Acad Dermatol Venereol 2016; 30:1295-302. [PMID: 27230832 DOI: 10.1111/jdv.13712] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
Abstract
Early diagnosis is extremely important for treatment and prognosis of skin cancer. Reflectance confocal microscopy (RCM) is a recently developed technique used to diagnose skin cancer. This meta-analysis was carried out to assess the accuracy of RCM for the diagnosis of malignant skin tumours. We conducted a systematic literature search of EMBASE, PubMed, the Cochrane Library and Web of Science database for relevant articles in English published up to 24 December 2015. The quality of the included studies was assessed using the QUADAS-2 tool. Statistical analyses were conducted using the software Meta-Disc version 1.4 and STATA version 12.0. A total of 21 studies involving 3108 patients with a total of 3602 lesions were included in the per-lesion analysis. The corresponding pooled results for sensitivity and specificity were 93.6% (95% CI: 0.92-0.95) and 82.7% (95% CI: 0.81-0.84) respectively. Positive likelihood ratio and negative likelihood ratio were 5.84 (95% CI: 4.27-7.98) and 0.08 (95% CI: 0.07-0.10) respectively. Subgroup analysis showed that RCM had a sensitivity of 92.7% (95% CI: 0.90-0.95) and a specificity of 78.3% (95% CI: 0.76-0.81) for detecting melanoma. The pooled sensitivity and specificity of RCM for detecting basal cell carcinoma were 91.7% (95% CI: 0.87-0.95) and 91.3% (95% CI: 0.94-0.96) respectively. RCM is a valid method of identifying malignant skin tumours accurately.
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Affiliation(s)
- Y D Xiong
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - S Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - X Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - X Zhong
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - C Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Q Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
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Gamo R, Florístan U, Pampín A, Caro D, Pinedo F, López-Estebaranz J. Usefulness of Confocal Microscopy in Distinguishing Between Basal Cell Carcinoma and Intradermal Melanocytic Nevus on the Face. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Utilidad de la microscopia confocal en el diagnóstico diferencial de epiteliomas basocelulares y nevus melanocíticos intradérmicos de localización facial. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:e41-4. [DOI: 10.1016/j.ad.2015.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 11/19/2022] Open
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13
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Gambichler T, Plura I, Schmid-Wendtner M, Valavanis K, Kulichova D, Stücker M, Pljakic A, Berking C, Maier T. High-definition optical coherence tomography of melanocytic skin lesions. JOURNAL OF BIOPHOTONICS 2015; 8:681-6. [PMID: 25237005 DOI: 10.1002/jbio.201400085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 05/26/2023]
Abstract
High-definition optical coherence tomography (HD-OCT) scanners have recently been developed. We assessed micromorphological HD-OCT correlates of benign naevi (BN) and malignant melanoma (MM). 28 BN and 20 MM were studied using HD-OCT and histology. Epidermal honeycomb/cobblestone pattern, regular junctional cell nests, and edged papillae are more often observed in BN, whereas fusion of rete ridges, pagetoid cells and junctional and/or dermal nests with atypical cells are more frequently seen in MM. A high overlap of HD-OCT features in BN and MM was observed and in 20% of MM we did not find evidence for malignancy in OCT images at all. Using HD-OCT it is possible to visualize architectural and cellular alterations of melanocytic skin lesions. The overlap of HD-OCT features seen in BN and MM and the absence of suspicious HD-OCT features in some MM represents an important limitation of HD-OCT affecting the sensitivity of HD-OCT in diagnosing MM. High-definition optical coherence tomography and the corresponding vertically sectioned histology of a compound naevus.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Iris Plura
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | | | - Konstantinos Valavanis
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Daniela Kulichova
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Markus Stücker
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Azem Pljakic
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Carola Berking
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Tanja Maier
- Department of Dermatology and Allergology, Ludwig-Maximilian University of Munich, Munich, Germany
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14
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Alarcon I, Carrera C, Palou J, Alos L, Malvehy J, Puig S. Impact of in vivo reflectance confocal microscopy on the number needed to treat melanoma in doubtful lesions. Br J Dermatol 2015; 170:802-8. [PMID: 24124911 DOI: 10.1111/bjd.12678] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The number needed to treat (NNT) ratio is an effective method for measuring accuracy in melanoma detection. Dermoscopy reduces the number of false positives and subsequently unnecessary excisions. In vivo reflectance confocal microscopy (RCM) is a noninvasive technique that allows examination of the skin with cellular resolution. OBJECTIVES To assess the impact of RCM analysis on the number of equivocal lesions, assumed to be melanocytic, excised for every melanoma. METHODS Consecutive patients (n = 343) presenting with doubtful lesions were considered for enrolment. The lesions were analysed by dermoscopy and RCM, with histopathological assessment considered the reference standard. The main outcome was the NNT, calculated as the proportion of equivocal lesions excised for every melanoma. RESULTS Dermoscopy alone obtained a hypothetical NNT of 3·73; the combination of dermoscopy and RCM identified 264 equivocal lesions that qualified for excision, 92 of which were confirmed to be a melanoma, resulting in an NNT of 2·87, whereas the analysis of RCM images classified 103 lesions as melanoma, with a consequent NNT of 1·12. The difference in the reduction of this ratio was statistically significant between the three groups (P < 0·0001). There was no significant improvement in sensitivity when comparing the combination of dermoscopy and RCM with RCM alone (94·6% vs. 97·8%; P = 0·043). However, the differences between specificities were statistically significant (P < 1 × 10(-6) ), favouring RCM alone. CONCLUSION The addition of RCM analysis to dermoscopy reduces unnecessary excisions with a high diagnostic accuracy and could be a means for reducing the economic impact associated with the management of skin cancer.
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Affiliation(s)
- I Alarcon
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Villarroel 170, Barcelona, 08036, Spain
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15
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16
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Gambichler T, Schmid-Wendtner M, Plura I, Kampilafkos P, Stücker M, Berking C, Maier T. A multicentre pilot study investigating high-definition optical coherence tomography in the differentiation of cutaneous melanoma and melanocytic naevi. J Eur Acad Dermatol Venereol 2014; 29:537-41. [DOI: 10.1111/jdv.12621] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | | | - I. Plura
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - P. Kampilafkos
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - M. Stücker
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - C. Berking
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich Germany
| | - T. Maier
- Department of Dermatology and Allergology; Ludwig-Maximilian University of Munich; Munich Germany
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Champin J, Perrot JL, Cinotti E, Labeille B, Douchet C, Parrau G, Cambazard F, Seguin P, Alix T. In vivo reflectance confocal microscopy to optimize the spaghetti technique for defining surgical margins of lentigo maligna. Dermatol Surg 2014; 40:247-56. [PMID: 24447286 DOI: 10.1111/dsu.12432] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lentigo maligna (LM) is a therapeutic challenge for surgeons because of its location in aesthetic areas and the difficulty in determining margins. OBJECTIVE To investigate a new procedure combining the "spaghetti" technique described by Gaudy-Marqueste and colleagues in 2011 with in vivo reflectance confocal microscopy (RCM) to define the margins of LM more accurately and allow strict histologic control. METHODS AND MATERIALS Thirty-three consecutive patients with LM of the head underwent a RCM-guided delineation of the margins followed by the "spaghetti" technique. RESULTS The excision of the first "spaghetti" in a tumor-free area was obtained in 28 of 33 patients. In the other five cases, persistence of LM foci was found in <5% of the length of spaghetti. The average number of pieces of "spaghetti" was 1.2 (range 1-3). Definitive histologic examination of the lesion showed a minimum average margin of 2.7 mm. Follow-up in 27 patients after an average of 10 months (range 4-25 months) did not show any recurrence. CONCLUSION This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.
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Affiliation(s)
- Julie Champin
- Department of Maxillofacial and Plastic Surgery, University Hospital of Saint Étienne, Saint-Étienne, France; Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France
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Masood A, Al-Jumaily AA. Computer aided diagnostic support system for skin cancer: a review of techniques and algorithms. Int J Biomed Imaging 2013; 2013:323268. [PMID: 24575126 PMCID: PMC3885227 DOI: 10.1155/2013/323268] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022] Open
Abstract
Image-based computer aided diagnosis systems have significant potential for screening and early detection of malignant melanoma. We review the state of the art in these systems and examine current practices, problems, and prospects of image acquisition, pre-processing, segmentation, feature extraction and selection, and classification of dermoscopic images. This paper reports statistics and results from the most important implementations reported to date. We compared the performance of several classifiers specifically developed for skin lesion diagnosis and discussed the corresponding findings. Whenever available, indication of various conditions that affect the technique's performance is reported. We suggest a framework for comparative assessment of skin cancer diagnostic models and review the results based on these models. The deficiencies in some of the existing studies are highlighted and suggestions for future research are provided.
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Affiliation(s)
- Ammara Masood
- School of Electrical, Mechanical and Mechatronic Engineering, University of Technology, Broadway Ultimo, Sydney, NSW 2007, Australia
| | - Adel Ali Al-Jumaily
- School of Electrical, Mechanical and Mechatronic Engineering, University of Technology, Broadway Ultimo, Sydney, NSW 2007, Australia
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Stevenson AD, Mickan S, Mallett S, Ayya M. Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions. Dermatol Pract Concept 2013; 3:19-27. [PMID: 24282659 PMCID: PMC3839827 DOI: 10.5826/dpc.0304a05] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/25/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Melanoma is a cancer of the skin and is increasing in incidence in the UK and Europe. Melanoma is a condition that is often curable if detected at an early stage, which makes accurate diagnosis vital. Reflectance confocal microscopy (RCM) is a tool used to image the skin. It gives high magnification images of the skin, which may provide more accurate diagnosis of lesions that are equivocal on clinical examination and dermoscopy. OBJECTIVE To determine the diagnostic accuracy of reflectance confocal microscopy (RCM), for melanoma diagnosis, as an add-on test to clinical examination and dermoscopy in the diagnosis of equivocal pigmented skin lesions using histopathology as the reference standard. METHODS A search was conducted of MEDLINE, EMBASE and six other electronic databases from inception to present. Forward citation searching and hand searching of reference lists were also conducted. Diagnostic accuracy studies that assess RCM in the diagnosis of melanoma were included in the review. Two contributors conducted the search, data extraction and assessment of methodological quality using QUADAS-2. Statistical analysis was performed using hierarchical bivariate random effects meta-analysis. RESULTS 951 titles and abstracts were screened. Five studies comprising 909 lesions were eligible for meta-analysis. Meta-analysis returned a per lesion sensitivity of 93% [95% CI 89-96] and a specificity of 76% [95% CI 68-83]. CONCLUSIONS The utility of reflectance confocal microscopy (RCM) as an add-on test for the diagnosis of melanoma depends on the trade off between over-excising benign lesions and misdiagnosing melanoma as benign. This becomes important when considering lesions on surgically difficult or cosmetically important areas of the body.
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Xu XG, Gao XH, Li YH, Chen HD. Ultrapulse-Mode Versus Superpulse-Mode Fractional Carbon Dioxide Laser on Normal Back Skin. Dermatol Surg 2013; 39:1047-55. [DOI: 10.1111/dsu.12174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schwartz RJ, Vera K, Navarrete N, Lobos P. In vivo reflectance confocal microscopy of halo nevus. J Cutan Med Surg 2013; 17:33-8. [PMID: 23364148 DOI: 10.2310/7750.2012.12019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND RCM (reflectance confocal microscopy) is a noninvasive, high-resolution technology that has been proven to improve the diagnostic accuracy over clinical examination in several skin diseases. OBJECTIVE The aim of this article is to describe the morphologic features of halo nevi (HN) observed with RCM and correlate them with their dermoscopic characteristics. METHOD Nine patients with the clinical diagnosis of HN were assessed with RCM. A second assessment was performed up to 12 months later. Dermoscopic global patterns were obtained and correlated with the RCM findings. RESULTS In five (55.6%) cases, pagetoid cells were observed. Nonedged dermal papilla and junctional thickening were found in three (33%) cases. Nucleated cells in the dermal papillae and plump bright cells were observed in seven (77.8%) and six (66.7%) cases, respectively. CONCLUSION Our study shows that HN observed by RCM can show atypical features that overlap with those observed on atypical melanocytic lesions and malignant melanoma.
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El Hallani S, Poh CF, Macaulay CE, Follen M, Guillaud M, Lane P. Ex vivo confocal imaging with contrast agents for the detection of oral potentially malignant lesions. Oral Oncol 2013; 49:582-90. [PMID: 23415144 DOI: 10.1016/j.oraloncology.2013.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/25/2013] [Accepted: 01/26/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We investigated the potential use of real-time confocal microscopy in the non-invasive detection of occult oral potentially malignant lesions. Our objectives were to select the best fluorescence contrast agent for cellular morphology enhancement, to build an atlas of confocal microscopic images of normal human oral mucosa, and to determine the accuracy of confocal microscopy to recognize oral high-grade dysplasia lesions on live human tissue. MATERIALS AND METHODS Five clinically used fluorescent contrast agents were tested in vitro on cultured human cells and validated ex vivo on human oral mucosa. Images acquired ex vivo from normal and diseased human oral biopsies with bench-top fluorescent confocal microscope were compared to conventional histology. Image analyzer software was used as an adjunct tool to objectively compare high-grade dysplasia versus low-grade dysplasia and normal epithelium. RESULTS Acriflavine Hydrochloride provided the best cellular contrast by preferentially staining the nuclei of the epithelium. Using topical application of Acriflavine Hydrochloride followed by confocal microscopy, we could define morphological characteristics of each cellular layer of the normal human oral mucosa, building an atlas of histology-like images. Applying this technique to diseased oral tissue specimen, we were also able to accurately diagnose the presence of high-grade dysplasia through the increased cellularity and changes in nuclear morphological features. Objective measurement of cellular density by quantitative image analysis was a strong discriminant to differentiate between high-grade dysplasia and low-grade dysplasia lesions. CONCLUSIONS Pending clinical investigation, real-time confocal microscopy may become a useful adjunct to detect precancerous lesions that are at high risk of cancer progression, direct biopsy and delineate excision margins.
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Affiliation(s)
- S El Hallani
- British Columbia Cancer Research Centre, Integrative Oncology Department and Cancer Imaging Unit, Vancouver, BC, Canada V5Z 1L3.
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Venius J, Zurauskas E, Rotomskis R. High resolution imaging of the human cardiac conduction system using reflectance confocal microscopy. TOHOKU J EXP MED 2012; 229:67-73. [PMID: 23269205 DOI: 10.1620/tjem.229.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rhythmical contraction of the heart is controlled by the cardiac conduction system (CCS) that consists of the three main parts: the sino-atrial node, the atrioventricular node and the His-Purkinje system. A heartbeat signal, originated from CCS, spreads through its branches to the different parts of the heart, initiating depolarization of the ventricles. However, this highly important system could not be distinguished visually from the surrounding heart tissues: myocardium (MC) and connective tissue (CT). Thus, during surgical procedures, CCS could be easily damaged; namely, the reliable method for identification of CCS either in vivo or ex vivo does not exist. Accordingly, there is a definite need for developing a CCS imaging method. Reflection confocal microscopy (RCM) offers non-destructive imaging of the tissue at depths of up to 0.35 mm with the capability of identification of a single cell. During the visualization procedure, a given tissue is illuminated with infrared laser light and the image is obtained because of different reflections from the tissue structures. However, the reflective structures in the heart tissues are still not identified. In the present study, for the first time we investigated cardiac tissues by RCM. The resolution of the method allowed us to distinguish MC cells and CCS cells. The method also allowed us to distinguish the network-like structures that are main components of CT. The ability to visualize different tissue components indicates a great potential for RCM to be used in non-destructive cardiac investigations and for imaging CCS.
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Affiliation(s)
- Jonas Venius
- Laboratory of Biomedical Physics of Vilnius University Institute of Oncology, Vilnius, Lithuania.
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Cinotti E, Perrot JL, Labeille B, Adegbidi H, Cambazard F. Reflectance Confocal Microscopy for the Diagnosis of Vulvar Melanoma and Melanosis: Preliminary Results. Dermatol Surg 2012; 38:1962-7. [DOI: 10.1111/dsu.12009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fritzsche C, Stachs O, Holtfreter MC, Nohr-Łuczak C, Guthoff RF, Reisinger EC. Confocal laser scanning microscopy, a new in vivo diagnostic tool for schistosomiasis. PLoS One 2012; 7:e34869. [PMID: 22529947 PMCID: PMC3328486 DOI: 10.1371/journal.pone.0034869] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/06/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The gold standard for the diagnosis of schistosomiasis is the detection of the parasite's characteristic eggs in urine, stool, or rectal and bladder biopsy specimens. Direct detection of eggs is difficult and not always possible in patients with low egg-shedding rates. Confocal laser scanning microscopy (CLSM) permits non-invasive cell imaging in vivo and is an established way of obtaining high-resolution images and 3-dimensional reconstructions. Recently, CLSM was shown to be a suitable method to visualize Schistosoma mansoni eggs within the mucosa of dissected mouse gut. In this case, we evaluated the suitability of CLSM to detect eggs of Schistosoma haematobium in a patient with urinary schistosomiasis and low egg-shedding rates. METHODOLOGY/PRINCIPAL FINDINGS The confocal laser scanning microscope used in this study was based on a scanning laser system for imaging the retina of a living eye, the Heidelberg Retina Tomograph II, in combination with a lens system (image modality). Standard light cystoscopy was performed using a rigid cystoscope under general anaesthesia. The CLSM endoscope was then passed through the working channel of the rigid cystoscope. The mucosal tissue of the bladder was scanned using CLSM. Schistoma haematobium eggs appeared as bright structures, with the characteristic egg shape and typical terminal spine. CONCLUSION/SIGNIFICANCE We were able to detect schistosomal eggs in the urothelium of a patient with urinary schistosomiasis. Thus, CLSM may be a suitable tool for the diagnosis of schistosomiasis in humans, especially in cases where standard diagnostic tools are not suitable.
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Affiliation(s)
- Carlos Fritzsche
- Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, University of Rostock, Rostock, Germany.
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Najm WI. Skin Cancer. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dreiseitl S, Pivec M, Binder M. Differences in examination characteristics of pigmented skin lesions: results of an eye tracking study. Artif Intell Med 2011; 54:201-5. [PMID: 22209476 DOI: 10.1016/j.artmed.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 10/14/2011] [Accepted: 11/17/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To use computer-based eye tracking technology to record and evaluate examination characteristics of the diagnosis of pigmented skin lesions. METHODOLOGY 16 study participants with varying levels of diagnostic expertise (little, intermediate, superior) were recorded while diagnosing a series of 28 digital images of pigmented skin lesions, obtained by non-invasive digital dermatoscopy, on a computer screen. Eye tracking hardware recorded the gaze track and fixations of the physicians while they examined the lesion images. Analysis of variance was used to test for differences in examination characteristics between physicians grouped according to expertise. RESULTS There were no significant differences between physicians with little and intermediate levels of expertise in terms of average time until diagnosis (6.61 vs. 6.19s), gaze track length (6.65 vs. 6.15 kilopixels), number of fixations (23.1 vs. 19.1), and time in fixations (4.91 vs. 4.17s). The experts were significantly different with 3.17s time until diagnosis, 4.53 kilopixels gaze track length, 9.9 fixations, and 1.74s in fixations, respectively. Differentiation between benign and malignant lesions had no effect on examination measurements. CONCLUSION The results show that experience level has a significant impact on the way in which lesion images are examined. This finding can be used to construct decision support systems that employ important diagnostic features identified by experts, and to optimize teaching for less experienced physicians.
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Affiliation(s)
- Stephan Dreiseitl
- Department of Software Engineering, University of Applied Sciences Upper Austria, Hagenberg, Austria.
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Shtirshnayder YY, Michenko AV, Katunina OR, Zubarev AR, SHTIRSHNEIDER YUYU, MICHENKO AV, KATUNINA OR, ZUBAREV AR. Up-to-date non-invasive visualization technologies in dermatology. VESTNIK DERMATOLOGII I VENEROLOGII 2011. [DOI: 10.25208/vdv1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors present a review of up-to-date non-invasive visualization methods used in diagnostics of diseases of skin
and its appendages. They describe physical principles forming the basis for non-invasive visualization methods such
as dermatoscopy, confocal laser scanning microscopy, optical video monitoring, optical topometry, optical coherent
tomography, ultrasound scanning, 3D-modeling. They also describe the potential of practical application of these diagnostics
methods at the current stage of their development. The authors have demonstrated that it is possible to reduce the clinicians
need in biopsy diagnostics due to the high information value of non-invasive visual diagnostics methods.
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Hashemi P, Pulitzer MP, Scope A, Kovalyshyn I, Halpern AC, Marghoob AA. Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: a challenge for melanoma diagnosis. J Am Acad Dermatol 2011; 66:452-62. [PMID: 21798622 DOI: 10.1016/j.jaad.2011.02.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/27/2010] [Accepted: 02/15/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Intraepidermal Langerhans cells (ILC) are difficult to differentiate from melanocytes under reflectance confocal microscopy (RCM) and their presence may simulate pagetoid spread of melanocytes on RCM images. OBJECTIVE We sought to correlate bright round and dendritic cells in a pagetoid pattern identified on RCM with findings of conventional histopathology and immunohistochemistry for lesions that were falsely diagnosed as melanoma by RCM. METHODS This retrospective study included histopathologically proven nevi, imaged by RCM, which displayed bright cells in a pagetoid pattern (BCPP) under RCM, resulting in the incorrect RCM diagnosis of melanoma. Morphological comparisons were made between RCM images of nevi showing BCPP, histopathologically proven melanomas displaying BCPP, and biopsy-proven nevi without BCPP. RESULTS We identified 24 nevi that were falsely diagnosed as melanoma by RCM because of the presence of BCPP. These pagetoid cells on RCM corresponded on histopathology to ILC with a high density in 23 of the 24 nevi (95%) and to melanocytes in 7 of the 24 nevi (29%). Among 6 melanomas displaying BCPP on RCM, ILC with high density were observed histopathologically in 5 of the 6 cases (83%) and pagetoid melanocytes were seen in all 6 cases (100%). LIMITATIONS The results cannot be generalized to clinically banal-appearing nevi. CONCLUSIONS Although the finding of BCPP is a useful RCM feature for the diagnosis of melanoma, it does not always imply the presence of pagetoid melanocytes but may at times represent ILC.
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Affiliation(s)
- Pantea Hashemi
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
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Richtig E, Ahlgrimm-Siess V, Arzberger E, Hofmann-Wellenhof R. Noninvasive differentiation between mamillary eczema and Paget disease by in vivo reflectance confocal microscopy on the basis of two case reports. Br J Dermatol 2011; 165:440-1. [DOI: 10.1111/j.1365-2133.2011.10380.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Confocal laser scanning microscopy for detection of Schistosoma mansoni eggs in the gut of mice. PLoS One 2011; 6:e18799. [PMID: 21533168 PMCID: PMC3078923 DOI: 10.1371/journal.pone.0018799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 03/20/2011] [Indexed: 11/24/2022] Open
Abstract
Background The gold standard for diagnosing Schistosoma mansoni infections is the detection of eggs from stool or biopsy specimens. The viability of collected eggs can be tested by the miracidium hatching procedure. Direct detection methods are often limited in patients with light or early infections, whereas serological tests and PCR methods fail to differentiate between an inactive and persistent infection and between schistosomal species. Recently, confocal laser scanning microscopy (CLSM) has been introduced as a diagnostic tool in several fields of medicine. In this study we evaluated CLSM for the detection of viable eggs of S. mansoni directly within the gut of infected mice. Methodology/Principal Findings The confocal laser scanning microscope used in this study is based on the Heidelberg Retina Tomograph II scanning laser system in combination with the Rostock Cornea Module (image modality 1) or a rigid endoscope (image modality 2). Colon sections of five infected mice were examined with image modalities 1 and 2 for schistosomal eggs. Afterwards a biopsy specimen was taken from each colon section and examined by bright-field microscopy. Visualised eggs were counted and classified in terms of viability status. Conclusions/Significance We were able to show that CLSM visualises eggs directly within the gut and permits discrimination of schistosomal species and determination of egg viability. Thus, CLSM may be a suitable non-invasive tool for the diagnosis of schistosomiasis in humans.
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Napp J, Mathejczyk JE, Alves F. Optical imaging in vivo with a focus on paediatric disease: technical progress, current preclinical and clinical applications and future perspectives. Pediatr Radiol 2011; 41:161-75. [PMID: 21221568 PMCID: PMC3032188 DOI: 10.1007/s00247-010-1907-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 09/20/2010] [Accepted: 10/10/2010] [Indexed: 12/30/2022]
Abstract
To obtain information on the occurrence and location of molecular events as well as to track target-specific probes such as antibodies or peptides, drugs or even cells non-invasively over time, optical imaging (OI) technologies are increasingly applied. Although OI strongly contributes to the advances made in preclinical research, it is so far, with the exception of optical coherence tomography (OCT), only very sparingly applied in clinical settings. Nevertheless, as OI technologies evolve and improve continuously and represent relatively inexpensive and harmful methods, their implementation as clinical tools for the assessment of children disease is increasing. This review focuses on the current preclinical and clinical applications as well as on the future potential of OI in the clinical routine. Herein, we summarize the development of different fluorescence and bioluminescence imaging techniques for microscopic and macroscopic visualization of microstructures and biological processes. In addition, we discuss advantages and limitations of optical probes with distinct mechanisms of target-detection as well as of different bioluminescent reporter systems. Particular attention has been given to the use of near-infrared (NIR) fluorescent probes enabling observation of molecular events in deeper tissue.
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Affiliation(s)
- Joanna Napp
- Department of Molecular Biology of Neuronal Signals, Max-Planck-Institute for Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany ,Department of Hematology and Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Julia E. Mathejczyk
- Department of Molecular Biology of Neuronal Signals, Max-Planck-Institute for Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Frauke Alves
- Department of Molecular Biology of Neuronal Signals, Max-Planck-Institute for Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany ,Department of Hematology and Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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Jin SE, Bae JW, Hong S. Multiscale observation of biological interactions of nanocarriers: from nano to macro. Microsc Res Tech 2010; 73:813-23. [PMID: 20232368 DOI: 10.1002/jemt.20847] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Microscopic observations have played a key role in recent advancements in nanotechnology-based biomedical sciences. In particular, multiscale observation is necessary to fully understand the nano-bio interfaces where a large amount of unprecedented phenomena have been reported. This review describes how to address the physicochemical and biological interactions of nanocarriers within the biological environments using microscopic tools. The imaging techniques are categorized based on the size scale of detection. For observation of the nanoscale biological interactions of nanocarriers, we discuss atomic force microscopy (AFM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). For the micro to macro-scale (in vitro and in vivo) observation, we focus on confocal laser scanning microscopy (CLSM) as well as in vivo imaging systems such as magnetic resonance imaging (MRI), superconducting quantum interference devices, and IVIS. Additionally, recently developed combined techniques such as AFM-CLSM, correlative light and electron microscopy (CLEM), and SEM spectroscopy are also discussed. In this review, we describe how each technique helps elucidate certain physicochemical and biological activities of nanocarriers such as dendrimers, polymers, liposomes, and polymeric/inorganic nanoparticles, thus providing a toolbox for bioengineers, pharmaceutical scientists, biologists, and research clinicians.
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Affiliation(s)
- Su-Eon Jin
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, USA
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Cyclin D1 and D3 expression in melanocytic skin lesions. Arch Dermatol Res 2010; 302:545-50. [PMID: 20496072 PMCID: PMC2913004 DOI: 10.1007/s00403-010-1054-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 05/11/2010] [Accepted: 05/11/2010] [Indexed: 11/09/2022]
Abstract
Cyclins, cyclin-dependent kinases, as well as proteins cooperating with them are responsible for cell cycle regulation which is crucial for normal development, injury repair, and tumorigenesis. D-type cyclins regulate G1 cell cycle progression by enhancing the activities of cyclin-dependent kinases, and their expression is frequently altered in tumors. Disturbances in cyclin expression were also reported in melanocytic skin lesions. The objective of the study was to evaluate the expression of cyclins D1 and D3 in common, dysplastic, and malignant melanocytic skin lesions. Forty-eight melanocytic skin lesions including common nevi (10), dysplastic nevi (24), and melanomas (14) were diagnosed by dermoscopy and excised. Expression of cyclin D1 and D3 was detected by immunohistochemistry and quantified as percentage of immunostained cell nuclei in each sample. In normal skin, expression of cyclins D1 and D3 was not detected. The mean percentage of cyclin D1-positive nuclei was 7.75% for melanoma samples, 5% for dysplastic nevi samples, and 0.34% for common nevi samples. For cyclin D3, the respective values were 17.8, 6.4, and 1.8%. Statistically significant differences in cyclin D1 expression were observed between melanomas and common nevi as well as between dysplastic and common nevi (p = 0.0001), but not between melanomas and dysplastic nevi. Cyclin D3 expression revealed significant differences between all investigated lesion types (p = 0.0000). The mean cyclin D1 and D3 scores of melanomas with Breslow thickness <1 mm and >1 mm were not significantly different. G1/S abnormalities are crucial for the progression of malignant melanoma, and enhanced cyclin D1 and D3 expression leading to increased melanocyte proliferation is observed in both melanoma and dysplastic nevi. In histopathologically ambiguous cases, lower cyclin D3 expression in dysplastic nevi can be a diagnostic marker for that lesion type.
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Eichert S, Möhrle M, Breuninger H, Röcken M, Garbe C, Bauer J. Diagnosis of cutaneous tumors with in vivo confocal laser scanning microscopy. J Dtsch Dermatol Ges 2010; 8:400-10. [PMID: 20141551 DOI: 10.1111/j.1610-0387.2010.07333.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In recent years, in vivo confocal laser scanning microscopy (CLSM) has become an established method for the non-invasive examination of the skin. In vivo CLSM allows for real-time imaging of micro-anatomic cutaneous structures. It has been used to diagnose ambiguous skin tumors and to measure subclinical tumor spread prior to surgery. By additionally providing high power morphologic information, in vivo CLSM helps to reduce unnecessary biopsies. A multitude of diagnostic features for skin tumors has been published. Here we review published diagnostic in vivo CLSM features, and compare them to our own experience in 100 tumors. In combination with clinical examination and dermatoscopy, in vivo CLSM is a valuable additional tool for non-invasive skin tumor diagnosis.
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Zakharov P, Talary MS, Kolm I, Caduff A. Full-field optical coherence tomography for the rapid estimation of epidermal thickness: study of patients with diabetes mellitus type 1. Physiol Meas 2009; 31:193-205. [PMID: 20016116 DOI: 10.1088/0967-3334/31/2/006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Changes in morphology of the skin are an important factor that can affect non-invasive measurements performed through this organ, in particular for glucose monitoring in e.g. patients with diabetes mellitus. A characterization technique for non-contact in vivo profiling of the superficial skin layers can be beneficial for evaluation of the performance of such measurement systems. We applied a full-field optical coherence tomography (OCT) system followed by the fully automatic processing for this task. With the developed procedure, non-invasive quantification of the skin morphology can be performed within a few minutes. The dorsal skin of the upper arm of 22 patients with Type 1 Diabetes Mellitus was investigated with an OCT system and with a commercially available dermatological laser scanning confocal microscope (CM) as a reference method. The estimates of epidermal thickness from OCT were compared with the results of expert-assisted analysis of confocal images. The highest correlation with the CM measurements has been obtained for the distance from the entrance peak to the first minimum of the OCT reflection profile (R2 = 0.657, p < 0.0001). In this specific patient group, we have observed a statistically significant correlation of the subjects' body mass index with the distance from the entrance peak to the dermal reflection peak in the OCT profile (p = 0.010). Furthermore, the same OCT parameter is negatively correlated with age with marginal statistical significance (p = 0.062). At the same time, no relation of diabetes-related parameters (duration of disease and concentration of glycated haemoglobin) to the skin morphology observed with the OCT and CM was found.
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Affiliation(s)
- P Zakharov
- Solianis Monitoring AG, Zurich, Switzerland
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Wang Q, Ornstein M, Kaufman HL. Imaging the immune response to monitor tumor immunotherapy. Expert Rev Vaccines 2009; 8:1427-37. [PMID: 19803763 DOI: 10.1586/erv.09.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of cancer immunotherapy is to promote antitumor immunity, and novel approaches include vaccination, adoptive transfer of tumor-reactive T cells, and administration of monoclonal antibodies and small molecules that target immune regulatory pathways. The molecular and cellular events responsible for tumor rejection are not completely defined and correlative studies have been used to help understand the mechanisms and extent of immune activation and tumor regression with these approaches. The real-time monitoring of immune responses to immunotherapy has been challenging as specific cell subsets may be difficult to define, and molecular pathways have evolved functionally diverse outcomes in different cells and in different tissues. Recently, improvements in optics and digital imaging have led to novel imaging techniques that make it possible to track the migration of individual immune cells ex vivo and in vivo, and to detect the dynamic interactions between T cells and antigen-presenting cells or tumor cells within complex microenvironments, including lymphoid tissue and established tumors. This review will explain some of the more established imaging techniques and discuss their role in monitoring the immune response in patients treated with various tumor immunotherapy approaches.
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Affiliation(s)
- Qin Wang
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA.
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Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol 2009; 62:247-56. [PMID: 19962214 DOI: 10.1016/j.jaad.2009.06.016] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 05/22/2009] [Accepted: 06/01/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND High variable-frequency ultrasound is a recently available technique capable of clearly defining skin layers and deeper structures that also provides local perfusion patterns obtained in real time. OBJECTIVES The aim of the study was to assess the performance of variable-frequency ultrasound in the evaluation of skin lesions. METHODS We performed a retrospective study of 4338 skin ultrasound examinations in predominantly localized skin lesions, and in a group of 130 healthy controls. We determined ultrasound sensitivity, specificity, and statistical level of certainty, and compared ultrasound diagnoses with clinical diagnoses. RESULTS Referring diagnosis was correct in 73% of the lesions, and addition of ultrasound increased correctness to 97% (P < .001 for the difference). Ultrasound overall sensitivity was 99%, specificity was 100%, and statistical diagnostic certainty was 99% LIMITATIONS Ultrasound in its current version cannot detect lesions that are epidermal only or that measure less than 0.1 mm in depth. CONCLUSIONS Ultrasound is a reliable adjuvant for the accurate and precise diagnosis of skin lesions.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:305-12. [DOI: 10.1097/spc.0b013e3283339c93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang X, Fujita M, Prado R, Tousson A, Hsu HC, Schottelius A, Kelly DR, Yang PA, Wu Q, Chen J, Xu H, Elmets CA, Mountz JD, Edwards CK. Visualizing CD4 T-cell migration into inflamed skin and its inhibition by CCR4/CCR10 blockades using in vivo imaging model. Br J Dermatol 2009; 162:487-96. [PMID: 19832835 DOI: 10.1111/j.1365-2133.2009.09552.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Chemokines are critical mediators of T-cell homing into inflamed skin. The complex nature of this multicellular response makes it difficult to analyse mechanisms mediating the early responses in vivo. OBJECTIVES To visualize directly T-cell homing into inflamed skin and its inhibition by blockades using a unique noninvasive confocal microscopy. MATERIALS AND METHODS A mouse model of allergic contact dermatitis was used. T cells from oxazolone-sensitized and -challenged Balb/c mice were first analysed phenotypically in vitro. CD4 T cells were then labelled with a tracker dye and transferred into Balb/c-SCID mice. The recipient mice were challenged with oxazolone and CD4 T-cell homing into inflamed skin was visualized. RESULTS T cells with the skin homing receptors CCR4 and CCR10 were increased in the affected skin and draining lymph nodes, and effectively attracted by their specific chemokines CCL17, CCL22 and CCL27 in vitro. Using in vivo imaging, T-cell migration into the inflamed skin was observed at 2 h after application, peaking at 12 h and continuing for 48 h. Simultaneous systemic administration of neutralizing antibodies against CCR4 ligands (CCL17 and CCL22) and CCR10 ligand (CCL27) led to a significant suppression of T-cell migration and skin inflammation. CONCLUSIONS Our data indicate that these tissue-selective adhesion molecules and chemokine/receptor pathways act in concert to attract specialized T-cell populations to mediate cutaneous inflammation. The in vivo imaging technique can be applicable to other models of cutaneous diseases to help with better understanding of the pathogenesis and monitoring the therapeutic effects.
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Affiliation(s)
- X Wang
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Richtig E, Gerger A, El-Shabrawi-Caelen L, Szkandera J, Hofmann-Wellenhof R. Reflectance confocal microscopy in early diagnosis of cutaneous metastases of breast cancer. Gynecol Oncol 2009; 115:510-1. [PMID: 19775735 DOI: 10.1016/j.ygyno.2009.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 08/24/2009] [Accepted: 08/29/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Erika Richtig
- Department of Dermatology, Medical University Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.
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