In vivo reflectance confocal microscopy of shave biopsy wounds: feasibility of intraoperative mapping of cancer margins
In vivo reflectance confocal microscopy of shave biopsy wounds: feasibility of intraoperative mapping of cancer margins
复制标题
DOI：
10.1111/j.1365-2133.2010.10063.x
复制
发表时间：
2010-12-01
影响因子：
10.3
通讯作者：
Rajadhyaksha, M.
中科院分区：
文献类型：
--
作者：
Scope, A.;Mahmood, U.;Rajadhyaksha, M.
背景反射共聚焦显微镜（RCM）在细胞分辨率下对皮肤进行成像，并已显示出对体内非黑色素瘤皮肤癌的诊断的效用。局部应用氯化铝（AlCl3）增强RCM图像的对比度，使核变亮。目的探讨AlCl3造影剂对剃须活检创面进行RCM成像的可行性。方法对体外组织进行AlCl3染色，以浓度和浸泡时间为优化指标。RCM成像方案在接受剃须活检的患者中进行了测试。回顾性分析RCM图像并与相应的组织病理学进行比较。结果临床常规止血用35% AlCl3，最小浸泡时间为1 min。我们在不同深度的RCM马赛克图像上发现了三种一致的边缘模式：表皮边缘、外周真皮边缘和深层真皮边缘。基底细胞癌的肿瘤岛位于外周或真皮深部边缘，在组织病理学上与肿瘤基底样细胞聚集相关。在鳞状细胞癌的表皮边缘发现非典型鹅卵石或蜂窝状图案，这与非典型角质形成细胞的增殖扩展到活检边缘有关。结论RCM成像对剃须活检创面是可行的，为手术创面术中定位提供了可能。
Background Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. Topical application of aluminium chloride (AlCl3) enhances contrast in RCM images by brightening nuclei.Objectives To investigate feasibility of RCM imaging of shave biopsy wounds using AlCl3 as a contrast agent.Methods AlCl3 staining was optimized, in terms of concentration vs. immersion time, on excised tissue ex vivo. RCM imaging protocol was tested in patients undergoing shave biopsies. The RCM images were retrospectively analysed and compared with the corresponding histopathology.Results For 35% AlCl3, routinely used for haemostasis in clinic, minimum immersion time was determined to be 1 min. We identified three consistent patterns of margins on RCM mosaic images by varying depth: epidermal margins, peripheral dermal margins, and deep dermal margins. Tumour islands of basal cell carcinoma were identified at peripheral or deep dermal margins, correlating on histopathology with aggregates of neoplastic basaloid cells. Atypical cobblestone or honeycomb patterns were identified at the epidermal margins in squamous cell carcinomas, correlating with a proliferation of atypical keratinocytes extending to biopsy margins.Conclusions RCM imaging of shave biopsy wounds is feasible and demonstrates the future possibility of intraoperative mapping in surgical wounds.