1
|
Farabi B, Atak MF, Harris U, Kahn J, Khan S, Fink V, Hartmann D, Rao BK, Jain M. Ex vivo confocal microscopy features of common benign lesions that mimic non-melanoma skin cancers: Towards clinical integration. JOURNAL OF BIOPHOTONICS 2024; 17:e202300386. [PMID: 38200691 DOI: 10.1002/jbio.202300386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Ex vivo confocal microscope (EVCM) rapidly images freshly excised tissue at a histopathological resolution. EVCM features of keratinocyte skin cancers are well-established, but those of benign clinical mimickers remain scarce. We describe EVCM features of common benign lesions and compare them with their malignant differentials. EVCM was used to image 14 benign and 3 cancer tissues. We compared EVCM features of benign lesions with corresponding histopathology and with those of keratinocyte cancers. Key features of benign lesions were identified and differentiated from malignant lesions. Elastin and fat appeared prominent in EVCM; while koilocytes and melanin were difficult to identify. Visualization of entire epidermis was challenging due to difficulty of tissue flattening during imaging. Benign lesions can be differentiated from keratinocyte cancers with EVCM. Using EVCM, a rapid, bedside diagnosis and management of skin neoplasms is possible, especially in a remote location without a histopathology lab.
Collapse
Affiliation(s)
- Banu Farabi
- New York Medical College, Valhalla, New York, USA
- Dermatology Department, NYC Health + Hospital/Metropolitan, New York, New York, USA
- Dermatology Department, NYC Health + Hospital/South Brooklyn, Brooklyn, New York, USA
| | - Mehmet Fatih Atak
- New York Medical College, Valhalla, New York, USA
- Internal Medicine Department, NYC Health + Hospitals/Metropolitan, New York, New York, USA
| | - Ucalene Harris
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julia Kahn
- New York Medical College, Valhalla, New York, USA
| | - Samavia Khan
- Dermatology Department, Rutgers University, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
| | - Veronica Fink
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Daniella Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Babar K Rao
- Dermatology Department, Rutgers University, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
- Dermatology Department, Weil Cornell Medicine, New York, New York, USA
| | - Manu Jain
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Dermatology Department, Weil Cornell Medicine, New York, New York, USA
| |
Collapse
|
2
|
Hartmann D. [Ex vivo confocal laser scanning microscopy for melanocytic lesions and autoimmune diseases]. Hautarzt 2021; 72:1058-1065. [PMID: 34705067 DOI: 10.1007/s00105-021-04906-1] [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] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ex vivo confocal laser scanning microscopy (CLSM) enables bedside histology and offers the surgeon a direct intraoperative tissue examination. OBJECTIVES To determine whether this innovative, ultra-fast diagnostic tool can be expanded beyond nonmelanoma skin cancer, particularly basal cell carcinoma, to other indications including melanocytic lesions and autoimmune diseases. MATERIALS AND METHODS Review of literature and summary of the current knowledge and experience of the use of ex vivo CLSM in melanocytic lesions and in autoimmune diseases. RESULTS Up to date experience of the use of ex vivo CLSM in melanocytic lesions and in autoimmune diseases is limited but promising. Current knowledge on melanocytic lesions in ex vivo CLSM and their examples together with classic ex vivo CLSM features are presented. Previous results on the use of ex vivo CLSM in autoimmune dermatoses are presented, and future application possibilities of ex vivo CLSM are discussed. CONCLUSIONS The method is particularly suitable for the rapid examination of basal cell carcinomas during Mohs surgery but could also be used in the future for the intraoperative examination of melanocytic and autoimmune skin lesions.
Collapse
Affiliation(s)
- D Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland.
| |
Collapse
|
3
|
Kose K, Fox CA, Rossi A, Jain M, Cordova M, Dusza SW, Ragazzi M, Gardini S, Moscarella E, Diaz A, Pigem R, Gonzalez S, Bennassar A, Carrera C, Longo C, Rajadhyaksha M, Nehal KS. An international 3-center training and reading study to assess basal cell carcinoma surgical margins with ex vivo fluorescence confocal microscopy. J Cutan Pathol 2021; 48:1010-1019. [PMID: 33576022 DOI: 10.1111/cup.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Novel solutions are needed for expediting margin assessment to guide basal cell carcinoma (BCC) surgeries. Ex vivo fluorescence confocal microscopy (FCM) is starting to be used in freshly excised surgical specimens to examine BCC margins in real time. Training and educational process are needed for this novel technology to be implemented into clinic. OBJECTIVE To test a training and reading process, and measure diagnostic accuracy of clinicians with varying expertise level in reading ex vivo FCM images. METHODS An international three-center study was designed for training and reading to assess BCC surgical margins and residual subtypes. Each center included a lead dermatologic/Mohs surgeon (clinical developer of FCM) and three additional readers (dermatologist, dermatopathologist, dermatologic/Mohs surgeon), who use confocal in clinical practice. Testing was conducted on 30 samples. RESULTS Overall, the readers achieved 90% average sensitivity, 78% average specificity in detecting residual BCC margins, showing high and consistent diagnostic reading accuracy. Those with expertise in dermatologic surgery and dermatopathology showed the strongest potential for learning to assess FCM images. LIMITATIONS Small dataset, variability in mosaic quality between centers. CONCLUSION Suggested process is feasible and effective. This process is proposed for wider implementation to facilitate wider adoption of FCM to potentially expedite BCC margin assessment to guide surgery in real time.
Collapse
Affiliation(s)
- Kivanc Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Manu Jain
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moira Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - Stefano Gardini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania L Vanvitelli, Naples, Italy
| | - Alba Diaz
- Pathology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Pigem
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Salvador Gonzalez
- Medicine and Medical Specialties Department, Alcalá de Henares University, Madrid, Spain
| | - Antoni Bennassar
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER) Instituto Carlos III, Madrid, Spain
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
4
|
Clinical Applications of In Vivo and Ex Vivo Confocal Microscopy. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11051979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Confocal laser scanning microscopy (CLSM) has been introduced in clinical settings as a tool enabling a quasi-histologic view of a given tissue, without performing a biopsy. It has been applied to many fields of medicine mainly to the skin and to the analysis of skin cancers for both in vivo and ex vivo CLSM. In vivo CLSM involves reflectance mode, which is based on refractive index of cell structures serving as endogenous chromophores, reaching a depth of exploration of 200 μm. It has been proven to increase the diagnostic accuracy of skin cancers, both melanoma and non-melanoma. While histopathologic examination is the gold standard for diagnosis, in vivo CLSM alone and in addition to dermoscopy, contributes to the reduction of the number of excised lesions to exclude a melanoma, and to improve margin recognition in lentigo maligna, enabling tissue sparing for excisions. Ex vivo CLSM can be performed in reflectance and fluorescent mode. Fluorescence confocal microscopy is applied for “real-time” pathological examination of freshly excised specimens for diagnostic purposes and for the evaluation of margin clearance after excision in Mohs surgery. Further prospective interventional studies using CLSM might contribute to increase the knowledge about its application, reproducing real-life settings.
Collapse
|
5
|
Ex Vivo Confocal Microscopy Using Fusion Mode and Digital Staining: Changing Paradigms in Histological Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
6
|
Pérez-Anker J, Malvehy J, Moreno-Ramírez D. Ex Vivo Confocal Microscopy Using Fusion Mode and Digital Staining: Changing Paradigms in Histological Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:236-242. [PMID: 31959303 DOI: 10.1016/j.ad.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
The ex vivo confocal microscope is an imaging system designed to analyze freshly excised tissue using two diode lasers with different wavelengths. The technique can dramatically reduce margin analysis times and offers a sensitivity of 88% and a specificity of 89% relative to histopathology. A new technology has recently been developed that produces images more quickly and with a higher resolution than before. By means of a fusion mode that combines simultaneously scanned fluorescence and reflectance images, it produces digitally stained images that simulate the effect of hematoxylin-eosin staining. Application of this new technology has opened the door to real-time tissue diagnostics.
Collapse
Affiliation(s)
- J Pérez-Anker
- Departamento de Dermatología, Hospital Clínic de Barcelona, Barcelona, España.
| | - J Malvehy
- Departamento de Dermatología, Hospital Clínic de Barcelona, Barcelona, España; IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - D Moreno-Ramírez
- Departamento de Dermatología, Hospital Clínic de Barcelona, Barcelona, España; Departamento de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| |
Collapse
|
7
|
Longo C, Pampena R, Bombonato C, Gardini S, Piana S, Mirra M, Raucci M, Kyrgidis A, Pellacani G, Ragazzi M. Diagnostic accuracy of ex vivo fluorescence confocal microscopy in Mohs surgery of basal cell carcinomas: a prospective study on 753 margins. Br J Dermatol 2019; 180:1473-1480. [PMID: 30512198 DOI: 10.1111/bjd.17507] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Frozen histological sections are used for intraoperative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool that offers a promising and faster alternative to frozen histology. OBJECTIVES To evaluate prospectively in a clinical setting the accuracy of FCM vs. frozen sections in margin assessment of basal cell carcinoma (BCC). METHODS Patients with BCC scheduled for Mohs surgery were prospectively enrolled. Freshly excised surgical specimens were examined by FCM and then frozen sections were evaluated. Permanent sections were obtained, in order to validate the sample technique. A blind re-evaluation was also performed for discordant cases. Sensitivity and specificity levels, as well as positive and negative predictive values (PPV and NPV, respectively), were calculated and receiver-operating characteristic curves generated. RESULTS We enrolled 127 BCCs in as many patients (40·2% females). Seven hundred and fifty-three sections were examined. All BCCs were located in the head and neck area. In evaluating the performance of FCM vs. frozen sections, sensitivity was 79·8%, specificity was 95·8%, PPV was 80·5% and NPV was 95·7% [area under the curve 0·88, 95% confidence interval 0·84-0·92 (P < 0·001)]. Forty-nine discordant cases were re-evaluated; 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment. CONCLUSIONS We found high levels of accuracy for FCM vs. frozen section evaluation in intraoperative BCC margin assessment during Mohs surgery. Some technical issues prevent the wide use of this technique, but new devices promise to overcome these limitations.
Collapse
Affiliation(s)
- C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - R Pampena
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - C Bombonato
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - S Gardini
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - S Piana
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - M Mirra
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - M Raucci
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - A Kyrgidis
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| |
Collapse
|
8
|
Peters N, Schubert M, Metzler G, Geppert JP, Moehrle M. Diagnostic accuracy of a new ex vivo confocal laser scanning microscope compared to H&E-stained paraffin slides for micrographic surgery of basal cell carcinoma. J Eur Acad Dermatol Venereol 2018; 33:298-304. [PMID: 30198589 DOI: 10.1111/jdv.15243] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND For safe excision of malignant skin tumours, complete negative surgical margins are mandatory. The gold standard for analysis is frozen sections or paraffin-embedded haematoxylin and eosin (H&E)-stained slides. The production of H&E-stained slides is time-consuming (>20 h) while wounds remain unclosed. An upcoming method is confocal laser scanning microscopy (CLSM), a technique that scans unfixed fresh tissue rapidly. OBJECTIVE Evaluation of the process to generate and analyse CLSM images and assessment of the accuracy to detect basal cell carcinoma (BCC) tissue. METHODS Digital microscopic images were generated by the Histolog Scanner v1 from 544 fresh specimens of 148 BCCs that had been stained with a 0.01% proflavine solution. CLSM images were compared to the histological diagnoses of the corresponding H&E-stained slides. RESULTS A total of 525 images could be analysed. The sensitivity was 73% (95% CI = [65.27%; 80.47%]), and the specificity was 96% (95% CI = [93.40%; 97.60%]). Detection of BCCs in punch biopsies was certainly detected (sensitivity of 100%). The median total time to generate and evaluate a CLSM image was 5.17 min (maximum 20.17 min and minimum 2.05 min). The greatest challenge was flattening the specimen to assure complete representation of the surgical margins. CONCLUSION Confocal laser scanning microscopy is a time-saving and very effective alternative to classical paraffin-embedded or frozen sections. Patient treatment could be improved due to shorter hospital stays or faster outpatient therapy due to reduced intervals between surgical stages. Diagnostic accuracy of the microscope used still must be improved.
Collapse
Affiliation(s)
- N Peters
- Department of Dermatology, University Hospital, Tuebingen, Germany
| | - M Schubert
- Department of Dermatology, University Hospital, Tuebingen, Germany.,Artemed Fachklinik Muenchen, Muenchen, Germany
| | - G Metzler
- Department of Dermatology, University Hospital, Tuebingen, Germany
| | | | - M Moehrle
- Department of Dermatology, University Hospital, Tuebingen, Germany.,Praxisklinik Tuebingen - Haut und Venen, Tuebingen, Germany
| |
Collapse
|
9
|
Teixeira DA, Rezze GG, Pinhal MAS, Paschoal FM. Reflectance confocal microscopy as a tool for screening surgical margins of basal cell carcinoma. An Bras Dermatol 2018; 93:601-604. [PMID: 30066778 PMCID: PMC6063104 DOI: 10.1590/abd1806-4841.20187089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/29/2017] [Indexed: 11/22/2022] Open
Abstract
Surgical excision of basal cell carcinoma with minimum margins requires serial assessment of layers by frozen histopathology in the case of Mohs micrographic surgery. Evaluation of presurgical tumor margins by in vivo reflectance confocal microscopy is a potential alternative. We selected 12 basal cell carcinoma lesions that were analyzed by confocal microscopy to define margins. The lesions were excised by Mohs surgery. Six tumors showed negative margins in the first phase of Mohs micrographic surgery. We concluded that reflectance confocal microscopy can be useful in the preoperative definition of basal cell carcinoma margins.
Collapse
Affiliation(s)
- Danilo Augusto Teixeira
- Graduate Master's Program in Health Sciences, Faculdade de Medicina do ABC, Santo André (SP), Brazil
- Outpatient Clinic for Dermatological Surgery of the Medical Residency Program, Hospital de Doenças Tropicais, Goiânia (GO), Brazil
| | | | | | | |
Collapse
|
10
|
Hartmann D, Krammer S, Bachmann MR, Mathemeier L, Ruzicka T, von Braunmühl T. Simple 3-criteria-based ex vivo confocal diagnosis of basal cell carcinoma. JOURNAL OF BIOPHOTONICS 2018; 11:e201800062. [PMID: 29726112 DOI: 10.1002/jbio.201800062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Fast and simple microscopic evaluation of basal cell carcinoma (BCC) together with its subtype determination would accelerate diagnostic and therapeutic procedures in dermatology including Mohs surgery. OBJECTIVES Assessing whether simplified 3-criteria-based ex vivo confocal microscopic (CM) examination can reliably predict BCC diagnosis and subtype. Analyzing interobserver agreement between expert and novice examiner. METHODS CM images of 235 skin samples from 150 patients were prospectively evaluated by 2 blinded examiners for the presence of 3 predefined BCC criteria namely presence of tumor mass, peripheral palisading and clefting. RESULTS Out of 235 skin samples 116 showed histological presence of BCC, confocally expert diagnosed a BCC in 110 and novice examiner in 107 samples. The overall sensitivity and specificity of detecting residual BCC was 96.6% and 98.7%, respectively. Confocally, examiners diagnosed correctly nodular BCC in 96.6%, respectively, 98.3%, superficial BCC in 96.8%, respectively, 93.5%, infiltrating BCC in 88.9%, respectively, 83.3% and other BCC subtype in 22.2%, respectively, 0% (expert and novice examiner, respectively). CONCLUSION Ex vivo CM allowed intraoperative examination of BCC based on only 3-criteria with high sensitivity and specificity, provided useful information on tumor subtype and showed that both experienced and non-experienced examiners may use this diagnostic approach with excellent results.
Collapse
Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital, Munich, Germany
| | - Mario R Bachmann
- Department of Dermatology and Allergy, University Hospital, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergy, University Hospital, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital, Munich, Germany
| | | |
Collapse
|
11
|
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
| |
Collapse
|
12
|
Hartmann D, Krammer S, Vural S, Bachmann MR, Ruini C, Sárdy M, Ruzicka T, Berking C, von Braunmühl T. Immunofluorescence and confocal microscopy for ex-vivo diagnosis of melanocytic and non-melanocytic skin tumors: A pilot study. JOURNAL OF BIOPHOTONICS 2018; 11:e201700211. [PMID: 28949458 DOI: 10.1002/jbio.201700211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/16/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Ex-vivo confocal laser scanning microscopy (ex-vivo CLSM) offers rapid examination of freshly excised tissue. During the conventional examination immunohistochemistry enables to distinguish various cell types. The possibility of immunofluorescent techniques could enhance the accuracy of the diagnosis performed by ex-vivo CLSM. METHODS The tissue probes from various skin tumors were stained with FITC-labeled S-100A10, Melan-A and anti-Ber-EP4 antibodies before examination with ex-vivo CLSM in the fluorescence and reflectance modes. Results were compared to negative controls and conventional histopathology. The staining protocols were evaluated by establishing a scoring system according to the signal intensity found in ex-vivo CLSM. RESULTS S100 immunostaining was successful in 55.6%. Dilution of 1:200 resulted in the best possible evaluation of the tumor. The best suitable protocol was protocol B (phosphate buffered saline [PBS], without blocking agent). Melan A immunostaining was positive in 66.7%, the best dilution was 1:500 and protocol B (PBS, without blocking agent) was the most suitable. Ber-EP4 immunostaining presented a signal in 85.7%, the best dilutions were 1:200 and 1:500 and protocol A (PBS, with blocking agent) showed most optimal results. CONCLUSION The use of fluorescent-labeled antibodies in ex-vivo CLSM is possible and could improve intraoperative diagnostics of skin tumors.
Collapse
Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Secil Vural
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | | | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| |
Collapse
|
13
|
Krishnamurthy S, Cortes A, Lopez M, Wallace M, Sabir S, Shaw K, Mills G. Ex Vivo Confocal Fluorescence Microscopy for Rapid Evaluation of Tissues in Surgical Pathology Practice. Arch Pathol Lab Med 2017; 142:396-401. [PMID: 29266968 DOI: 10.5858/arpa.2017-0164-oa] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Optical imaging techniques are currently available for imaging tissues without the need for any type of extensive tissue preparation. There are several applications for their potential use in surgical pathology practice. OBJECTIVE - To evaluate the feasibility of using a confocal fluorescence microscopy (CFM) platform for ex vivo examination of tissues obtained from surgical resections of breast, lung, kidney, and liver. DESIGN - Tissue fragments (0.5-1.0 cm) were immersed in 0.6 mM acridine orange for 6 seconds and imaged using a CFM platform at a 488-nm wavelength. The imaged tissues were subsequently fixed in formalin and processed routinely to generate hematoxylin-eosin-stained tissue sections. Mosaics of the grayscale CFM images were studied at different magnifications for recognition of the tissue and were compared with conventional histopathologic examination of hematoxylin-eosin tissue sections. RESULTS - We imaged 55 tissue fragments obtained from 16 breast (29%), 18 lung (33%), 14 kidney (25%), and 7 liver (13%) surgical excision specimens. Acridine orange labeled the nuclei, creating the contrast between nucleus and cytoplasm and thereby recapitulating the tissue architecture. We could obtain CFM images of good quality within 5 to 10 minutes that allowed recognition of the cytomorphologic details for categorization of the imaged tissue and were similar to histologic examination of hematoxylin-eosin tissue sections. CONCLUSIONS - The ease and speed of acquisition of CFM images together with the resolution and resemblance of the CFM images to hematoxylin-eosin sections suggest that the CFM platform has excellent potential for use in surgical pathology practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Gordon Mills
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Interventional Radiology (Ms Cortes and Drs Wallace and Sabir), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Ms Lopez and Drs Shaw and Mills), and the Department of Systems Biology (Dr Mills), The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Abeytunge S, Larson B, Peterson G, Morrow M, Rajadhyaksha M, Murray MP. Evaluation of breast tissue with confocal strip-mosaicking microscopy: a test approach emulating pathology-like examination. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:34002. [PMID: 28327961 PMCID: PMC5361391 DOI: 10.1117/1.jbo.22.3.034002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/27/2017] [Indexed: 05/23/2023]
Abstract
Confocal microscopy is an emerging technology for rapid imaging of freshly excised tissue without the need for frozen- or fixed-section processing. Initial studies have described imaging of breast tissue using fluorescence confocal microscopy with small regions of interest, typically 750 × 750 ?? ? m 2 . We present exploration with a microscope, termed confocal strip-mosaicking microscope (CSM microscope), which images an area of 2 × 2 ?? cm 2 of tissue with cellular-level resolution in 10 min of excision. Using the CSM microscope, we imaged 34 fresh, human, large breast tissue specimens from 18 patients, blindly analyzed by a board-certified pathologist and subsequently correlated with the corresponding standard fixed histopathology. Invasive tumors and benign tissue were clearly identified in CSM strip-mosaic images. Thirty specimens were concordant for image-to-histopathology correlation while four were discordant.
Collapse
Affiliation(s)
- Sanjee Abeytunge
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States
| | - Bjorg Larson
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States
- Drew University, Physics Department, Madison, New Jersey, United States
| | - Gary Peterson
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States
| | - Monica Morrow
- Memorial Sloan Kettering Cancer Center, Breast Service, New York, New York, United States
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States
| | - Melissa P. Murray
- Memorial Sloan Kettering Cancer Center, Breast Pathology, New York, New York, United States
| |
Collapse
|
16
|
Jain M, Rajadhyaksha M, Nehal K. Implementation of fluorescence confocal mosaicking microscopy by "early adopter" Mohs surgeons and dermatologists: recent progress. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:24002. [PMID: 28199474 PMCID: PMC5310648 DOI: 10.1117/1.jbo.22.2.024002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/20/2017] [Indexed: 05/06/2023]
Abstract
Confocal mosaicking microscopy (CMM) enables rapid imaging of large areas of fresh tissue ex vivo without the processing that is necessary for conventional histology. When performed in fluorescence mode using acridine orange (nuclear specific dye), it enhances nuclei-to-dermis contrast that enables detection of all types of basal cell carcinomas (BCCs), including micronodular and thin strands of infiltrative types. So far, this technique has been mostly validated in research settings for the detection of residual BCC tumor margins with high sensitivity of 89% to 96% and specificity of 99% to 89%. Recently, CMM has advanced to implementation and testing in clinical settings by “early adopter” Mohs surgeons, as an adjunct to frozen section during Mohs surgery. We summarize the development of CMM guided imaging of ex vivo skin tissues from bench to bedside. We also present its current state of application in routine clinical workflow not only for the assessment of residual BCC margins in the Mohs surgical setting but also for some melanocytic lesions and other skin conditions in clinical dermatology settings. Last, we also discuss the potential limitations of this technology as well as future developments. As this technology advances further, it may serve as an adjunct to standard histology and enable rapid surgical pathology of skin cancers at the bedside.
Collapse
Affiliation(s)
- Manu Jain
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
- Address all correspondence to: Manu Jain, E-mail:
| | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
| | - Kishwer Nehal
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
| |
Collapse
|
17
|
Hartmann D, Ruini C, Mathemeier L, Bachmann MR, Dietrich A, Ruzicka T, von Braunmühl T. Identification of ex-vivo confocal laser scanning microscopic features of melanocytic lesions and their histological correlates. JOURNAL OF BIOPHOTONICS 2017; 10:128-142. [PMID: 27091702 DOI: 10.1002/jbio.201500335] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 06/05/2023]
Abstract
Ex-vivo confocal laser scanning microscopy (CLSM) offers rapid tissue examination. Current literature shows promising results in the evaluation of non-melanoma skin cancer but little is known about presentation of melanocytic lesions (ML). This study evaluates ML with ex-vivo CLSM in comparison to histology and offers an overview of ex-vivo CLSM characteristics. 31 ML were stained with acridine orange or fluorescein and examined using ex-vivo CLSM (Vivascope2500® ; Lucid Inc; Rochester NY) in reflectance and fluorescence mode. Confocal images were correlated to histopathology. Benign and malignant features of the ML were listed and results were presented. Sensitivity and specificity were calculated using contingency tables. The ML included junctional, compound, dermal, Spitz and dysplastic nevi, as well as various melanoma subtypes. The correlation of the confocal findings with histopathology allowed the identification of different types of ML and differentiation of benign and malignant features. The study offers an overview of confocal characteristics of ML in comparison to histology. Ex-vivo CLSM does not reproduce the typical in-vivo horizontal mosaics but rather reflects the vertical histological presentation. Not all typical in-vivo patterns are detectable here. These findings may help to evaluate the ex-vivo CLSM as an adjunctive tool in the immediate intraoperative diagnosis of ML. Superficial spreading malignant melanoma. Histopathology (H&E stain; 200×) correlated to the reflectance (RM; 830 nm) and fluorescence mode (FM; 488 nm) in the ex-vivo CLSM (Vivablock® by VivaScan® , acridine orange).
Collapse
Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Cristel Ruini
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Mario Raphael Bachmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Andreas Dietrich
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
- Department of Dermatology, Municipal Hospital of Munich, Thalkirchner Str. 48, 80337, Munich, Germany
| |
Collapse
|
18
|
Iovieno A, Longo C, De Luca M, Piana S, Fontana L, Ragazzi M. Fluorescence Confocal Microscopy for Ex Vivo Diagnosis of Conjunctival Tumors: A Pilot Study. Am J Ophthalmol 2016; 168:207-216. [PMID: 27296488 DOI: 10.1016/j.ajo.2016.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the potential use of fluorescence confocal microscopy (FCM) for ex vivo diagnosis and excision margin assessment of conjunctival neoplasms. DESIGN Validity study. METHODS setting: Single institution. PARTICIPANTS Consecutive patients with clinically suspicious conjunctival lesions. INTERVENTION Conjunctival lesions were excised in toto using a standard "no-touch technique" by a single surgeon (A.I.). Collected specimens were examined with a commercially available laser scanning fluorescence confocal microscope after immersion in a 0.6 mM solution of acridine orange dye for 10-20 seconds. Specimens were subsequently processed with standard histologic analysis. MAIN OUTCOME MEASURES FCM diagnosis of the nature and extension of conjunctival lesions. RESULTS Sixteen consecutive patients were included in the study (11 male, 5 female; mean age 58.1 ± 26.1 years, range 10-90 years). The median time needed to process and analyze a sample with FCM was 15 minutes. Eleven of 16 lesions were identified by FCM as squamous (2 benign papillomas, 2 grade 2 conjunctival intraepithelial neoplasias, 7 in situ squamous carcinomas) and 5 as nonsquamous (1 pingueculum, 1 dermolipoma, 2 melanocytic nevi, 1 melanoma). In all cases FCM was able to detect horizontal and vertical extension of the lesion. All FCM findings were confirmed by corresponding subsequent histologic examination. CONCLUSIONS FCM provides a fast ex vivo preliminary diagnosis of suspicious conjunctival lesions with good histologic details and margin assessment, and may represent a novel tool for intraoperative and postsurgical management of conjunctival tumors. This is the first study to investigate ex vivo FCM application in ophthalmology.
Collapse
|
19
|
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.
Collapse
|
20
|
Correlation of histological and ex-vivo confocal tumor thickness in malignant melanoma. Lasers Med Sci 2016; 31:921-7. [DOI: 10.1007/s10103-016-1936-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
|
21
|
Hartmann D, Ruini C, Mathemeier L, Dietrich A, Ruzicka T, von Braunmühl T. Identification of ex-vivo confocal scanning microscopic features and their histological correlates in human skin. JOURNAL OF BIOPHOTONICS 2016; 9:376-387. [PMID: 25996548 DOI: 10.1002/jbio.201500124] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
Ex-vivo confocal laser scanning microscopy (CLSM) is an emerging diagnostic tool allowing fast and easy microscopic tissue examination. The first generation of ex-vivo devices have already shown promising results in the ex-vivo evaluation of basal cell carcinoma compared to Mohs surgery. Nevertheless, for the diagnostics of pathological skin lesions the knowledge of normal skin features is essential. Therefore we examined 50 samples of healthy skin from various donor sites including head and neck (n = 25), trunk (n = 10), upper (n = 10) and lower extremities (n = 5) using a new generation ex-vivo CLSM device offering three different laser wavelengths and compared the findings to the corresponding histological sections. In correlation with the histopathology we identified different layers of the epidermis, differentiated keratinocytes from melanocytes and described in detail skin appendages including hair follicle, sebaceous and sweat glands. Furthermore, structures of the dermis and subcutis were illustrated. Additionally, artefacts and pitfalls occurring with the use of ex-vivo CLSM have been documented. The study offers an overview of the main ex-vivo CLSM skin characteristics in comparison to the standard histological examination and helps to recognize and avoid common artefacts. Anatomy of a hair follicle in the reflectance mode (RM) CLSM, fluorescence mode (FM) CLSM and in a routine hematoxylin-eosin stained histological section (H).
Collapse
Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
| | - Cristel Ruini
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Andreas Dietrich
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| |
Collapse
|
22
|
Green B, Tsiroyannis C, Brennan PA. Optical diagnostic systems for assessing head and neck lesions. Oral Dis 2016; 22:180-4. [DOI: 10.1111/odi.12398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- B Green
- Department of General Medicine; Torbay Hospital; Torquay UK
| | - C Tsiroyannis
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| | - PA Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| |
Collapse
|
23
|
Venturini M, Gualdi G, Zanca A, Lorenzi L, Pellacani G, Calzavara-Pinton PG. A new approach for presurgical margin assessment by reflectance confocal microscopy of basal cell carcinoma. Br J Dermatol 2015; 174:380-5. [PMID: 26498991 DOI: 10.1111/bjd.14244] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical excision represents the most common elective treatment for basal cell carcinoma (BCC). Several noninvasive approaches have been proposed for in vivo determination of tumour margin, in order to achieve radical removal. OBJECTIVES To propose a new approach through the combination of dermoscopy and reflectance confocal microscopy (RCM) for lateral margin detection in BCC. METHODS Ten patients with lesions clinically suggestive of nonpigmented BCCs with ill-defined margins were enrolled. All BCCs were dermoscopically evaluated first and the ill-defined margins were marked with a superficial cut and then inspected using RCM. RESULTS RCM evaluation showed BCC foci beyond the presurgical marker in three out of 10 lesions. Histology confirmed the RCM results: the presence of BCC features across the cut, corresponding to two superficial BCCs and a morpheaform BCC. CONCLUSIONS This new procedure helped to improve the identification of proper margins for surgical excision in nonpigmented BCC with clinically and dermoscopically ill-defined margins.
Collapse
Affiliation(s)
- M Venturini
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - G Gualdi
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - A Zanca
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - L Lorenzi
- Department of Pathology, University of Brescia, Brescia, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | |
Collapse
|
24
|
Optical diagnostic techniques for use in lesions of the head and neck: review of the latest developments. Br J Oral Maxillofac Surg 2014; 52:675-80. [DOI: 10.1016/j.bjoms.2014.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/16/2014] [Indexed: 11/20/2022]
|
25
|
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
| |
Collapse
|