Confocal laser microscopic imaging of actinic keratoses in vivo:: A preliminary report
Confocal laser microscopic imaging of actinic keratoses in vivo:: A preliminary report
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DOI：
10.1067/mjd.2000.105565
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发表时间：
2000-07-01
影响因子：
13.8
通讯作者：
González, S
中科院分区：
文献类型：
--
作者：
Aghassi, D;Anderson, RR;González, S
背景：实时近红外共聚焦激光扫描显微镜（CM）为确认光化性角化病（AK）的临床诊断提供了一种前所未有的方法，无需活检。方法：对7例临床诊断为AK的患者在病变及邻近正常皮肤上行CM显像。从4例患者推定的ak处获得活检标本。结果：CM检出角化过度（71%）、下表皮核肿大及多形性（100%）、结构紊乱（57%）等病变病理特征。相比之下，1例患者（17%）在邻近的临床正常皮肤上出现明显的细胞学异型性和结构紊乱。4个活检标本中3个证实了AK的临床诊断，而1个显示浸润性鳞状细胞癌。在没有优化CM成像角化过度皮肤病变的情况下，只有3个病变的有限穿透深度达到了基底层，其他病变无法检测到真皮侵犯。结论：浸润深度目前是CM诊断AKs的主要限制，特别是在肥厚性和角化过度病变中，这两种病变更容易恶性。然而，CM可能成为活检的一种替代方法，其局限性可能会被未来光学穿透技术的进步或简单地去除角化过度的角质层所克服。
Background: Real-time near-infrared confocal laser scanning microscopy (CM) offers an unprecedented method for confirming the clinical diagnosis of actinic keratosis (AK) without biopsy.Methods: Seven patients with clinically diagnosed AK underwent CM imaging over the lesion and over adjacent normal-appearing skin. Biopsy specimens were obtained From the presumed AKs in 4 patients.Results: CM detected lesional pathologic features of hyperkeratosis (71%), lower epidermal nuclear enlargement and pleomorphism (100%), and architectural disarray (57%). In contrast, cytologic atypia and architectural disarray were apparent in one patient (17%) over the adjacent, clinically normal skin. Three of 4 biopsy specimens confirmed the clinical diagnosis of AK, whereas one revealed invasive squamous cell carcinoma. Without optimizing CM for imaging hyperkeratotic skin lesions, the limited depth of penetration reached the stratum basale in only 3 lesions, precluding detection of dermal invasion in the others.Conclusion: Depth of penetration currently imposes a major limitation on CM in the diagnosis of AKs, especially in hypertrophic and hyperkeratotic lesions, which are more likely to be malignant. However, CM may become an alternative to biopsy, and its limitations may be overcome by future technologic advances in optical penetration or by simply removing the hyperkeratotic stratum corneum.