Intra-operative confocal imaging-guided Mohs surgery

术中共聚焦成像引导莫氏手术

• 批准号: 6801944
• 负责人: MILIND RAJADHYAKSHA
• 金额: $ 30.72万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-20 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6801944
• 关键词: adolescence (12-20); adult human (21+); aluminum; basal cell carcinoma; bioengineering /biomedical engineering; bioimaging /biomedical imaging; biomedical equipment development; chloride ion; clinical research; human subject; image guided surgery /therapy; imaging /visualization /scanning; microscopy

DESCRIPTION (provided by applicant): The goal of this proposal is to develop and clinically test a real-time optical imaging modality based on confocal reflectance microscopy, with enhancement of nuclear-to-dermal contrast using acetic acid and crossed polarization, to intra-operatively examine basal cell cancers to guide Mohs micrographic surgery. Basal cell cancers (BCCs) are among the fastest growing cancers (>1.2 million new USA cases/year); because they occur most frequently on older people and in high risk anatomical sites (near or on the eyes, mouth, nose, ears), precise microsurgery is necessary with minimum damage to the surrounding normal tissue. Mohs surgery is time-consuming (one to several hours) and tedious because several (2-20) excisions must be made, and frozen histology sections carefully prepared and examined for each. Realtime confocal reflectance imaging may make Mohs surgery significantly more efficient by enabling direct intraoperative examination for cancer nests and cancer-to-normal tissue margins on the patient; this will reduce the number of excisions and avoid frozen histology. Both the patient and surgeon will save several hours per procedure in the operating room. Although proposed for Mohs surgery of BCCs, this real-time intra-operative imaging modality may, in fact, prove useful in a variety of other microsurgical settings. The research will be a collaboration between Northeastern University (Boston) and Memorial Sloan-Kettering Cancer Center (New York). This project will be implemented in two phases: (1) an ex vivo study using freshly excised skin specimens from Mohs surgeries, to (a) design a confocal microscope that mimics the Mohs surgeon's examination of frozen histology: rapid low-resolution examination of BCC nests in wide fields-of-view followed by high-resolution inspection of nuclear morphology in small fields-of-view, and develop (b) optimum contrast enhancement methods using topical acetic acid (induces condensation of chromatin that increases light backscatter from nuclei) and optical crossed polarization (suppresses light backscatter from the surrounding normal dermis), (c) optimum hemostasis methods using either topical aluminum chloride or electrocautery, (d) image understanding by detailed correlation of images to histology; and (2) an intraoperative study, involving (a) design of a specialized confocal articulated telescope, to enable (b) imaging of BCCs on patients during surgery, to evaluate the optimum contrast enhancement and hemostasis methods, correlate confocal images to histology and quantitatively determine diagnostic/screening accuracy. The overall goal is to develop an optical (confocal) intra-operative imaging instrument for Mohs and other modes of microsurgery.

描述（由申请人提供）： 该提案的目标是开发和临床测试基于共聚焦反射显微镜的实时光学成像模式，使用乙酸和交叉偏振增强核-真皮对比度，以术中检查基底细胞癌，指导莫氏显微手术。基底细胞癌（BCC）是增长最快的癌症之一（> 120万新发病例/年）;因为它们最常发生在老年人和高风险解剖部位（靠近或在眼睛，嘴，鼻子，耳朵上），精确的显微手术是必要的，对周围正常组织的损伤最小。莫氏手术耗时（一到几个小时）且繁琐，因为必须进行几次（2-20次）切除，并仔细准备冷冻组织学切片并对每个切片进行检查。实时共焦反射成像可以使莫氏手术更有效，使术中直接检查癌巢和癌对正常组织边缘的病人;这将减少切除的数量，并避免冷冻组织学。患者和外科医生在手术室中每次手术都将节省几个小时。虽然建议用于基底细胞癌的莫氏手术，但实际上，这种实时术中成像方式可能在各种其他显微外科设置中证明是有用的。这项研究将是东北大学（波士顿）和纪念斯隆-凯特琳癌症中心（纽约）之间的合作。该项目将分两个阶段实施：（1）使用Mohs手术新鲜切除的皮肤标本进行体外研究，以（a）设计一种模拟Mohs外科医生检查冷冻组织学的共聚焦显微镜：在宽视场中快速低分辨率检查BCC巢，然后在小视场中高分辨率检查核形态，并开发（B）使用局部乙酸的最佳对比度增强方法（诱导染色质凝聚，增加来自细胞核的光反向散射）和光学交叉偏振（抑制来自周围正常真皮的光反向散射），（c）使用局部氯化铝或电烙术的最佳止血方法，（d）通过图像与组织学的详细相关性来理解图像;以及（2）术中研究，包括（a）设计专门的共焦关节式望远镜，以使得（B）能够在手术期间对患者的BCC进行成像，以评估最佳对比度增强和止血方法，将共焦图像与组织学相关联，并定量地确定诊断/筛选准确性。总体目标是开发一种光学（共焦）术中成像仪器的莫氏和其他模式的显微外科手术。