Validation Of Fluorescent Confocal Microscopy Criteria And Histopathological Correlation For The Diagnosis Of Basal Cell Carcinoma And Most Common Subtypes.
Bennàssar A, Vilata A, Puig S, Malvehy J.
Source
Dermatology Department, Melanoma Unit. Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain.
Abstract
BACKGROUND:
Ex vivo fluorescence confocal microscopy (FCM) enables a real-time imaging of skin morphology directly in freshly excised tissue. FCM displays wide field-of-view mosaics with cellular resolution, thus enabling a rapid bedside-pathology. An application of interest is rapid detection of residual basal cell carcinoma (BCC) in skin excisions during Mohs surgery.
OBJECTIVES:
We sought to evaluate sensitivity (Se) and specificity (Sp) of ex vivo imaging with FCM for the detection of residual BCC in Mohs tissue excisions and calculate the time invested up to the diagnosis for both FCM and frozen sections.
METHODS:
Eighty consecutive BCC were prospectively collected and the margins scanned with ex vivo FCM, including excisions with and without residual BCC of all major subtypes. Each mosaic was divided into two or four resulting in 480 sub-mosaics for study. Every confocal sub-mosaic was assessed for the presence or absence of BCC and compared with standard frozen sections as the "gold standard". Furthermore, the time spent for each technique was calculated and compared.
RESULTS:
The overall sensitivity and specificity of detecting residual BCC was 88% and 99%, respectively. Moreover the new technique reduced by almost two thirds the time invested when compared with the processing of a frozen section (p < 0.001).
CONCLUSIONS:
The results demonstrate the feasibility of confocal mosaicing microscopy in fresh tissue for rapid surgical pathology to potentially expedite and guide Mohs surgery with high accuracy. This observation is an important step towards the goal of using real-time surgical pathology for skin tumours. This article is protected by copyright. All rights reserved.
Bennàssar A, Vilata A, Puig S, Malvehy J.
Source
Dermatology Department, Melanoma Unit. Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain.
Abstract
BACKGROUND:
Ex vivo fluorescence confocal microscopy (FCM) enables a real-time imaging of skin morphology directly in freshly excised tissue. FCM displays wide field-of-view mosaics with cellular resolution, thus enabling a rapid bedside-pathology. An application of interest is rapid detection of residual basal cell carcinoma (BCC) in skin excisions during Mohs surgery.
OBJECTIVES:
We sought to evaluate sensitivity (Se) and specificity (Sp) of ex vivo imaging with FCM for the detection of residual BCC in Mohs tissue excisions and calculate the time invested up to the diagnosis for both FCM and frozen sections.
METHODS:
Eighty consecutive BCC were prospectively collected and the margins scanned with ex vivo FCM, including excisions with and without residual BCC of all major subtypes. Each mosaic was divided into two or four resulting in 480 sub-mosaics for study. Every confocal sub-mosaic was assessed for the presence or absence of BCC and compared with standard frozen sections as the "gold standard". Furthermore, the time spent for each technique was calculated and compared.
RESULTS:
The overall sensitivity and specificity of detecting residual BCC was 88% and 99%, respectively. Moreover the new technique reduced by almost two thirds the time invested when compared with the processing of a frozen section (p < 0.001).
CONCLUSIONS:
The results demonstrate the feasibility of confocal mosaicing microscopy in fresh tissue for rapid surgical pathology to potentially expedite and guide Mohs surgery with high accuracy. This observation is an important step towards the goal of using real-time surgical pathology for skin tumours. This article is protected by copyright. All rights reserved.
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