Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma.
Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma.
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DOI：
10.1001/jamadermatol.2017.3114
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发表时间：
2017-12-01
期刊：
影响因子：
10.9
通讯作者：
Rossi AM
中科院分区：
文献类型：
--
作者：
Yélamos O;Cordova M;Blank N;Kose K;Dusza SW;Lee E;Rajadhyaksha M;Nehal KS;Rossi AM
恶性lentigo （LM）和LM黑色素瘤（LMM）的管理是具有挑战性的，因为它广泛的亚临床扩散和发生在化妆品敏感区域。反射共聚焦显微镜（RCM）提高了LM/LMM的诊断准确性，并可用于描绘其边缘。目的：评估手持式RCM与桡骨影像成像（HRCM-RV）是否能提供准确的LM/LMM边缘术前评估。前瞻性研究纳入2016年3月至2017年3月期间连续咨询手术治疗的头颈部活检证实的LM/LMM患者。32例患者采用HRCM-RV成像。最终，23例LM/LMM进行了分期手术，并参与了分析。临床病变大小及面积、基于HRCM的LM/LMM面积、HRCM预测的手术缺损面积、观察到的手术缺损面积。我们还根据HRCM计算了每个象限实现肿瘤清除所需的毫米，并将其与实际手术切缘进行比较。HRCM-RV预测的平均手术缺损面积为6.3 cm2，手术切除边缘清晰的平均面积为7.7 cm2。总体而言，在控制患者年龄和既往手术的情况下，手术切缘平均比HRCM-RV预测值大0.76 mm （95% CI: 0.67 - 0.84, p<0.001）。HRCM-RV映射的LM/LMM预测相似，但略小，缺陷比分期切除。因此，使用HRCM-RV绘制LM图可以减少临床不确定区域的活检次数，从而节省健康组织，并可用于规划LM/LMM的治疗并适当地为患者提供建议。
The management of lentigo maligna (LM) and LM melanoma (LMM) is challenging because of extensive subclinical spread and its occurrence on cosmetically-sensitive areas. Reflectance confocal microscopy (RCM) improves diagnostic accuracy for LM/LMM and can be used to delineate its margins. To evaluate whether handheld RCM with radial videomosaicking (HRCM-RV) offers accurate LM/LMM margin presurgical assessment. Prospective study involving consecutive patients with biopsy-proven LM/LMM located on the head-and-neck area who consulted for surgical management from March 2016 to March 2017. Dermatology Service, Memorial Sloan Kettering Cancer Center, New York Thirty-two patients were imaged using HRCM-RV. Ultimately, 23 LM/LMM underwent staged surgery and contributed to the analysis. Clinical lesion size and area, LM/LMM area based on HRCM, surgical defect area predicted by HRCM, and observed surgical defect area. We also calculated the millimeters needed to achieve tumor clearance in each quadrant based on HRCM and compared them with the actual surgical margins. The mean surgical defect area predicted with HRCM-RV was 6.3 cm2 and the mean area of surgical excision with clear margins was 7.7 cm2. Overall, controlling for patient age and previous surgery, surgical margins were on average 0.76 mm larger than the HRCM-RV prediction (95% CI: 0.67– 0.84, p<0.001). HRCM-RV mapping of LM/LMM predicts similar, but slightly smaller, defects than staged excision. Thus, mapping of LM using HRCM-RV can result in sparing of healthy tissue by reducing the number of biopsies in clinically-uncertain areas and may be used to plan treatment of LM/LMM and counsel patients appropriately.
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DOI：
10.1097/gox.0000000000000272
发表时间：
2015-02
期刊：
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影响因子：
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作者：
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