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Feasibility of intraoperative imaging during Mohs surgery with reflectance confocal microscopy

机译：反射共聚焦显微镜在莫氏手术中术中成像的可行性

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摘要

Mohs surgery for the removal of non-melanoma skin cancers (NMSCs) is performed in stages, while being guided by the examination for residual tumor with frozen pathology. However, preparation of frozen pathology at each stage is time-consuming and labor-intensive. Real-time intraoperative reflectance confocal microscopy (RCM) may enable rapid detection of residual tumor directly in surgical wounds on patients. We report initial feasibility on twenty-one patients, using 35% AlCl_3 for nuclear contrast. Imaging was performed in quadrants in the wound, to simulate the Mohs surgeon's examination of pathology. Images and videos of the epidermal and dermal margins were found to be of clinically acceptable quality. Bright nuclear morphology was identified at the epidermal margin. The presence of residual BCC/SCC tumor and normal skin features could be detected in the peripheral and deep dermal margins. Nuclear morphology was detectable in residual BCC/SCC tumors. Intraoperative RCM imaging may enable detection of residual tumor, directly on Mohs patients, and may serve as an adjunct for frozen pathology. However, a stronger source of contrast will be necessary, and also a smaller device with an automated approach for imaging in the entire wound in a rapid and controlled manner for clinical utility.
机译：Mohs手术用于分期进行非黑素瘤皮肤癌（NMSCs）切除术，同时以冷冻病理学检查残余肿瘤为指导。然而，在每个阶段准备冷冻病理学既费时又费力。实时术中反射共聚焦显微镜（RCM）可以直接在患者的手术伤口中快速检测残留肿瘤。我们报告了对21名患者的初步可行性，使用35％AlCl_3进行核对比。在伤口的象限中进行成像，以模拟莫氏外科医生的病理检查。发现表皮和真皮边缘的图像和视频具有临床可接受的质量。在表皮边缘鉴定出明亮的核形态。可以在周围和深层真皮边缘检测到残留的BCC / SCC肿瘤和正常皮肤特征。在残留的BCC / SCC肿瘤中可检测到核形态。术中RCM成像可直接在Mohs患者上检测残留的肿瘤，并可作为冷冻病理的辅助手段。然而，将需要更强的对比度源，并且还需要具有自动方法的较小设备，以便以快速且可控的方式在整个伤口中成像，以用于临床。

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