In vivo real-time confocal reflectance microscopy:: A noninvasive guide for mohs micrographic surgery facilitated by aluminum chloride, an excellent contrast enhancer
In vivo real-time confocal reflectance microscopy:: A noninvasive guide for mohs micrographic surgery facilitated by aluminum chloride, an excellent contrast enhancer
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DOI：
10.1046/j.1524-4725.2003.29219.x
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发表时间：
2003-08-01
影响因子：
2.4
通讯作者：
González, S
中科院分区：
文献类型：
--
作者：
Tannous, Z;Torres, A;González, S
背景莫氏显微外科（MMS）是基于显微镜控制切除皮肤肿瘤，并提供最高的治愈率与最大的组织保护。在体内共聚焦显微镜（CM）允许非侵入性光学成像薄切片的活皮肤，在其自然状态下，在真实的时间，具有高分辨率和对比度。评价使用体内CM作为MM手术引导的可行性。5例活检证实的基底细胞癌（BCC）患者在临床可见皮肤癌的一个或两个部位通过体内CM成像。然后切除第一个莫氏层，并将新鲜冷冻切片与CM结果相关联。将20%氯化铝（AlCl）应用于Mohs缺损，然后在每个病变的一个部位进行体内CM。随后切除第二个莫氏层，并将新鲜冷冻切片与CM结果相关联。切除第一和第二莫氏层后，苏木精和伊红染色的冷冻切片证实了体内CM的发现。发现AlCl提供BCC细胞和周围组织之间的极好对比，用体内和离体CM两者容易检测到。与未使用AlCl的低对比度暗核相比，使用AlCl的肿瘤细胞显示出强烈的亮核，具有良好的对比度。体内CM是MMS的潜在手术指南，而AlCl提供了一种极好的外源性试剂来增强CM的肿瘤对比度。
BACKGROUND. Mohs micrographic surgery (MMS) is based on microscopically controlled excision of cutaneous neoplasms and offers the highest cure rates with maximum tissue preservation. In vivo confocal microscopy (CM) allows noninvasive optical imaging of thin sections of living skin, in its native state, in real time, with high resolution and contrast.OBJECTIVE. To evaluate the feasibility of the use of in vivo CM as a surgical guide in MMS.METHODS. Five patients with a biopsy-proven basal cell carcinoma (BCC) were imaged by in vivo CM on one or two sites from the clinically visible skin cancer. The first Mohs layer was then excised, and the fresh-frozen sections were correlated with the CM findings. Aluminum chloride (AlCl) 20% was applied on the Mohs defect followed by in vivo CM on one site from each lesion. A second Mohs layer was subsequently excised, and fresh-frozen sections were correlated with CM findings.RESULTS. The findings of in vivo CM were confirmed by hematoxylin and eosin-stained frozen sections after excisions of the first and second Mohs layers. AlCl was found to provide an excellent contrast between BCC cells and the surrounding tissue, detected readily with both in vivo and ex vivo CM. The tumor cells with AlCl exhibited intensely bright nuclei with an excellent contrast as compared with the low-contrast dark nuclei without AlCl application.CONCLUSION. In vivo CM is a potential surgical guide for MMS, and AlCl provides an excellent exogenous agent to enhance tumor contrast for CM.