Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology
Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology
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DOI：
10.1046/j.0022-202x.2001.01524.x
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发表时间：
2001-11-01
影响因子：
6.5
通讯作者：
González, S
中科院分区：
文献类型：
--
作者：
Rajadhyaksha, M;Menaker, G;González, S
精确切除非黑色素瘤癌，对周围正常皮肤的损伤最小，是由莫氏显微外科手术中每次切除的组织病理学检查指导的。冷冻组织病理学切片的制备通常需要每次切除20-45分钟。实时共聚焦反射显微镜提供了一种成像方法，有可能避免冷冻组织病理学和准备非侵入性（光学）切片在5分钟内。皮肤切除（约1毫米厚）从莫氏手术用5%的乙酸洗涤，并与共聚焦交叉偏振显微镜成像。将共焦图像与相应的组织病理学进行比较。乙酸导致染色质的致密化，从而增加光的反向散射，并使细胞核明亮且易于检测。交叉偏振强烈地增强了细胞核的对比度，因为致密的染色质使照明光去偏振，而周围的细胞质和正常真皮则不会。在宽视野中对癌小叶进行快速低分辨率检查，然后在小视野中对核形态进行高分辨率检查是可能的;这与检查组织病理学切片的程序相似。莫氏外科医生和病人每天都有可能在手术室节省几个小时。快速共焦反射显微镜检查切除（任何厚度），可以提高管理的外科病理学和指导显微外科手术的任何人体组织。
Precise removal of nonmelanoma cancers with minimum damage to the surrounding normal skin is guided by the histopathologic examination of each excision during Mohs micrographic surgery. The preparation of frozen histopathology sections typically requires 20-45 min per excision. Real-time confocal reflectance microscopy offers an imaging method potentially to avoid frozen histopathology and prepare noninvasive (optical) sections within 5 min. Skin excisions (approximate to 1 mm thick) from Mohs surgeries were washed with 5% acetic acid and imaged with a confocal cross-polarized microscope. The confocal images were compared with the corresponding histopathology. Acetic acid causes compaction of chromatin that increases light back-scatter and makes the nuclei bright and easily detectable. Crossed-polarization strongly enhances the contrast of the nuclei because the compacted chromatin depolarizes the illumination light whereas the surrounding cytoplasm and normal dermis does not. Fast low-resolution examination of cancer lobules in wide fields of view followed by high-resolution inspection of nuclear morphology in small fields of view is possible; this is similar to the procedure for examining histopathology sections. Both the Mohs surgeon and the patient will potentially save several hours per day in the operating room. Fast confocal reflectance microscopic examination of excisions (of any thickness) may improve the management of surgical pathology and guide microsurgery of any human tissue.