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Forchhammer S, Grunewald S, Möhrle M, Metzler G, Eigentler T, Münch AK, Ogrzewalla H. Diagnosis of Basal Cell Carcinoma with Ex-vivo Confocal Laser Scanning Microscopy in a Real-life Setting. Acta Derm Venereol 2023; 103:adv4859. [PMID: 36994776 PMCID: PMC10108614 DOI: 10.2340/actadv.v103.4859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
Ex-vivo confocal laser scanning microscopy provides a rapid alternative to routine histological processing using haematoxylin and eosin-stained sections. Previous studies suggest high diagnostic accuracy in basal cell carcinoma. This study investigates the diagnostic accuracy of confocal laser scanning microscopy reporting of basal cell carcinoma in a real-life setting and compares reporting by dermatopathologists inexperienced in use of confocal laser scanning microscopy with reporting by an expert in confocal laser scanning microscopy. A total of 334 confocal laser scanning microscopy scans were diagnosed by 2 dermatopathologists inexperienced in the diagnosis of confocal laser scanning microscopy as well as an experienced examiner of confocal laser scanning microscopy scans. The inexperienced examiners achieved a sensitivity of 59.5/71.1% and specificity of 94.8/89.8%. The experienced examiner achieved a sensitivity of 78.5% and specificity of 84.8%. Detection of tumour remnants in margin controls showed insufficient values among inexperienced (30.1/33.3%) and experienced (41.7%) investigators. The results of this study, of real-life setting basal cell carcinoma reporting with confocal laser scanning microscopy, found a lower diagnostic accuracy than published data regarding artificial settings. A poor accuracy in tumour margin control is clinically relevant and could restrict the use of confocal laser scanning microscopy in clinical routine. Prior knowledge of haematoxylin and eosin trained pathologists can be partially transferred to the reporting of confocal laser scanning microscopy scans; however, specific training is recommended.
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Affiliation(s)
- Stephan Forchhammer
- Department of Dermatology, University Hospital Tübingen, Eberhardt Karls University, Tübingen, Germany.
| | - Sonja Grunewald
- Clinic and Polyclinic for Dermatology, Venerology and Allergology, Leipzig, Germany
| | | | - Gisela Metzler
- Center for Dermatohistology and Oral Pathology Tübingen/Würzburg, Tübingen, Germ
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne-Kristin Münch
- Institute for Clinical Epidemiology and Applied Biometry, Eberhardt Karls University, Tübingen, Germany
| | - Hanna Ogrzewalla
- Department of Dermatology, University Hospital Tübingen, Eberhardt Karls University, Tübingen, Germany
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2
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Peters N, Schubert M, Bauer J, Ghoreschi FC, Moehrle M. Rapid Lump Examination (RLE) – eine schnelle Methode in der mikroskopisch kontrollierten Chirurgie von Basalzellkarzinomen. J Dtsch Dermatol Ges 2019; 17:1131-1140. [PMID: 31765084 DOI: 10.1111/ddg.13937_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Juergen Bauer
- Universitäts-Hautklinik Tübingen.,Dermatologie in Stuttgart
| | | | - Matthias Moehrle
- Universitäts-Hautklinik Tübingen.,Praxisklinik Tübingen - Haut und Venen, Tübingen
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3
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Peters N, Schubert M, Bauer J, Ghoreschi FC, Moehrle M. Rapid Lump Examination (RLE) – a bedside 3‐dimensional microscopy of tumor specimens. J Dtsch Dermatol Ges 2019; 17:1131-1139. [DOI: 10.1111/ddg.13937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Nina Peters
- Department of DermatologyUniversity Medical Center Tuebingen Tuebingen Germany
| | | | - Juergen Bauer
- Department of DermatologyUniversity Medical Center Tuebingen Tuebingen Germany
- Dermatologie in Stuttgart Stuttgart Germany
| | | | - Matthias Moehrle
- Department of DermatologyUniversity Medical Center Tuebingen Tuebingen Germany
- Praxisklinik Tübingen – Haut und Venen Tuebingen Germany
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4
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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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5
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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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6
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Videodermoscopy and Curettage: The Value of Simple Procedures During Mohs Surgery. Dermatol Surg 2017; 43:1411-1417. [DOI: 10.1097/dss.0000000000001247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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8
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Espinasse M, Cinotti E, Grivet D, Labeille B, Prade V, Douchet C, Cambazard F, Thuret G, Gain P, Perrot JL. ‘En face’ ex vivo
reflectance confocal microscopy to help the surgery of basal cell carcinoma of the eyelid. Clin Exp Ophthalmol 2017; 45:442-447. [DOI: 10.1111/ceo.12904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/01/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Marine Espinasse
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
| | - Elisa Cinotti
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
| | - Damien Grivet
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
| | - Bruno Labeille
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
| | - Virginie Prade
- Department of Oral and Maxillofacial Surgery; University Hospital of St-Etienne; Saint Etienne France
| | - Catherine Douchet
- Department of Pathology; University Hospital of St-Etienne; Saint Etienne France
| | - Frédéric Cambazard
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
| | - Gilles Thuret
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
- University Institute of France; Paris France
| | - Philippe Gain
- Department of Ophthalmology; University Hospital of St-Etienne; Saint Etienne France
- Department of Biology, Engineering and Imaging of Corneal Graft Laboratory, Institute of Research in Sciences and Health Engineering, EA2512; Jean Monnet University; Saint-Etienne France
| | - Jean Luc Perrot
- Department of Dermatology; University Hospital of St-Etienne; Saint Etienne France
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9
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Löser CR, Rompel R, Möhrle M, Häfner HM, Kunte C, Hassel J, Hohenleutner U, Podda M, Sebastian G, Hafner J, Kaufmann R, Breuninger H. S1 guideline: microscopically controlled surgery (MCS). J Dtsch Dermatol Ges 2016; 13:942-51. [PMID: 26882393 DOI: 10.1111/ddg.12665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
When using procedures that enable complete examination of surgical margins (3D histology), microscopically controlled surgery (MCS) represents a safe and proven method to confirm R0 resection of infiltrating tumors, especially at problematic sites, while preserving the adjacent tissue. This allows for excellent or good aesthetic results that are superior (cryosurgery, short-range irradiation) or equivalent (PDT) to nonsurgical and less safe procedures (PDT).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jürg Hafner
- Dermatologische Klinik, Universitätsspital Zürich
| | - Roland Kaufmann
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt
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10
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Abstract
First developed in 1957, confocal microscopy is a powerful imaging tool that can be used to obtain near real-time reflected light images of untreated human tissue with nearly histologic resolution. Besides its research applications, in the last decades, confocal microscopy technology has been proposed as a useful device to improve clinical diagnosis, especially in ophthalmology, dermatology, and endomicroscopy settings, thanks to advances in instrument development. Compared with the wider use of the in vivo tissue assessment, ex vivo applications of confocal microscopy are not fully explored. A comprehensive review of the current literature was performed here, focusing on the reliable applications of ex vivo confocal microscopy in surgical pathology and on some potential evolutions of this new technique from pathologists' viewpoint.
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11
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Löser CR, Rompel R, Möhrle M, Häfner HM, Kunte C, Hassel J, Hohenleutner U, Podda M, Sebastian G, Hafner J, Kaufmann R, Breuninger H. S1-Leitlinie: Mikroskopisch kontrollierte Chirurgie (MKC). J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.140_12665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jürg Hafner
- Dermatologische Klinik; Universitätsspital Zürich
| | - Roland Kaufmann
- Klinik für Dermatologie; Venerologie und Allergologie, Universitätsklinikum Frankfurt
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12
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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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13
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Longo C, Rajadhyaksha M, Ragazzi M, Nehal K, Gardini S, Moscarella E, Lallas A, Zalaudek I, Piana S, Argenziano G, Pellacani G. Evaluating
ex vivo
fluorescence confocal microscopy images of basal cell carcinomas in
M
ohs excised tissue. Br J Dermatol 2014; 171:561-70. [DOI: 10.1111/bjd.13070] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/27/2022]
Affiliation(s)
- C. Longo
- Dermatology and Skin Cancer Unit Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - M. Rajadhyaksha
- Dermatology Service Memorial Sloan Kettering Cancer Center 160 E 53rd St New York NY 10022 U.S.A
| | - M. Ragazzi
- Department of Pathology Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - K. Nehal
- Dermatology Service Memorial Sloan Kettering Cancer Center 160 E 53rd St New York NY 10022 U.S.A
| | - S. Gardini
- Dermatology and Skin Cancer Unit Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - E. Moscarella
- Dermatology and Skin Cancer Unit Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - A. Lallas
- Dermatology and Skin Cancer Unit Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - I. Zalaudek
- Dermatology and Skin Cancer Unit Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
- Department of Dermatology University of Graz Graz Austria
| | - S. Piana
- Department of Pathology Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - G. Argenziano
- Dermatology and Skin Cancer Unit Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico – IRCCS) Viale Risorgimento, 80 42100 Reggio Emilia Italy
| | - G. Pellacani
- Department of Dermatology University of Modena and Reggio Emilia Modena Italy
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Larson B, Abeytunge S, Seltzer E, Rajadhyaksha M, Nehal K. Detection of skin cancer margins in Mohs excisions with high-speed strip mosaicing confocal microscopy: a feasibility study. Br J Dermatol 2014; 169:922-6. [PMID: 23701464 DOI: 10.1111/bjd.12444] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fluorescence confocal mosaicing microscopy is an emerging technology for rapid imaging of nuclear and morphological detail directly in excised tissue, without the need for frozen or fixed section processing. Basal cell carcinomas (BCCs) can be detected with high sensitivity and specificity in Mohs excisions with this approach. For translation to clinical trials and towards potentially routine implementation, a new and faster approach called strip mosaicing confocal microscopy was recently developed. OBJECTIVES To perform a preliminary assessment of fluorescence strip mosaicing confocal microscopy for detecting skin cancer margins in Mohs excisions. METHODS Tissue samples from 17 Mohs cases were imaged in the form of strip mosaics. Each mosaic was divided into two halves (submosaics) and graded by a Mohs surgeon and a dermatologist who were blinded to the pathology. The 34 submosaics were compared with the corresponding Mohs pathology. RESULTS The overall image quality was excellent for resolution, contrast and stitching in the 34 submosaics. Components of normal skin including the epidermis, dermis, dermal appendages and subcutaneous tissue were easily visualized. The preliminary measures of sensitivity and specificity were both 94% for detecting skin cancer margins. CONCLUSIONS The new strip mosaicing approach represents another advance in confocal microscopy for imaging of large areas of excised tissue. Strip mosaicing may enable rapid assessment of BCC margins in fresh excisions during Mohs surgery and may serve as an adjunct to frozen pathology.
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Affiliation(s)
- B Larson
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 160 E 53rd St, New York, NY, 10022, U.S.A
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Bennàssar A, Vilata A, Puig S, Malvehy J. Ex vivo
fluorescence confocal microscopy for fast evaluation of tumour margins during Mohs surgery. Br J Dermatol 2014; 170:360-5. [DOI: 10.1111/bjd.12671] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. Bennàssar
- Melanoma Unit Dermatology Department Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer) Villarroel 170 08036 Barcelona Spain
| | - A. Vilata
- Melanoma Unit Dermatology Department Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer) Villarroel 170 08036 Barcelona Spain
| | - S. Puig
- Melanoma Unit Dermatology Department Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer) Villarroel 170 08036 Barcelona Spain
- Investigación Biomédica en Red en Enfermedades Raras (CIBERER) Barcelona Spain
| | - J. Malvehy
- Melanoma Unit Dermatology Department Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer) Villarroel 170 08036 Barcelona Spain
- Investigación Biomédica en Red en Enfermedades Raras (CIBERER) Barcelona Spain
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16
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Longo C, Ragazzi M, Castagnetti F, Gardini S, Palmieri T, Lallas A, Moscarella E, Piana S, Pellacani G, Zalaudek I, Argenziano G. Inserting ex vivo Fluorescence Confocal Microscopy Perioperatively in Mohs Micrographic Surgery Expedites Bedside Assessment of Excision Margins in Recurrent Basal Cell Carcinoma. Dermatology 2013; 227:89-92. [DOI: 10.1159/000353577] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022] Open
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17
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Maier T, Kulichová D, Ruzicka T, Kunte C, Berking C. Ex vivo
high-definition optical coherence tomography of basal cell carcinoma compared to frozen-section histology in micrographic surgery: a pilot study. J Eur Acad Dermatol Venereol 2012; 28:80-5. [DOI: 10.1111/jdv.12063] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Moehrle M, Käflein L, Ziefle S, Metzler G. Rapid lump examination (RLE) - a new tool for Mohs surgery? J Dtsch Dermatol Ges 2011; 9:534-8. [PMID: 21496206 DOI: 10.1111/j.1610-0387.2011.07692.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND "Micrographic surgery" spares tissue and results in fewer recurrences. Various techniques have been described using paraffin-embedded and cryostat sections or even optical sections from ex vivo confocal laser scanning microscopy. The presented technique is the rapid direct microscopy of the surface of a specimen (lump) for a pathological examination (RLE). METHODS Fresh surgical tissue was stained first without sectioning and then was examined directly under microscope. A 95 sec staining protocol for basal cell carcinoma (BCC) was established. 129 specimens were examined using a digital microscope and 78 specimens using a stereo microscope. RESULTS RLE had a high diagnostic accuracy compared to paraffin-embedded H&E-stained sections. Sensitivity and specificity of RLE was 91 % and 90 % for the digital and 90 % and 94 % for the stereo microscope. In addition we developed a 7 min RLE-immunohistology protocol using the BerEp4-antibody. DISCUSSION RLE is a simple and accurate technique for fresh tissue examination. Here, the technique has been established for BCC but the principle may also be transferred to histological bedside diagnosis of other tumors. The technique does not alter or destroy tissue, so that after RLE was done subsequent conventional histology is still possible. RLE might yield a time- and cost-saving diagnosis in micrographic surgery.
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