Confocal mosaicing microscopy in Mohs skin excisions: feasibility of rapid surgical pathology Journal Article


Authors: Gareau, D. S.; Li, Y.; Huang, B.; Eastman, Z.; Nehal, K. S.; Rajadhyaksha, M.
Article Title: Confocal mosaicing microscopy in Mohs skin excisions: feasibility of rapid surgical pathology
Abstract: Mosaicing of confocal images enables observation of nuclear morphology in large areas of tissue. An application of interest is rapid detection of basal cell carcinomas (BCCs) in skin excisions during Mohs surgery. A mosaic is currently created in less than 9 min, whereas preparing frozen histology requires 20 to 45 min for an excision. In reflectance mosaics, using acetic acid as a contrast agent to brighten nuclei, large and densely nucleated BCC tumors were detectable in fields of view of 12 x 12 mm (which is equivalent to a 2x-magnified view as required by Mohs surgeons). However, small and sparsely nucleated tumors remained undetectable. Their diminutive size within the large field of view resulted in weak light backscatter and contrast relative to the bright surrounding normal dermis. In fluorescence, a nuclear-specific contrast agent may be used and light emission collected specifically from nuclei but almost none from the dermis. Acridine orange of concentration 1 mM stains nuclei in 20 s with high specificity and strongly enhances nuclear-to-dermis contrast of BCCs. Comparison of fluorescence mosaics to histology shows that both large and small tumors are detectable. The results demonstrate the feasibility of confocal mosaicing microscopy toward rapid surgical pathology to potentially expedite and guide surgery.
Keywords: clinical trial; methodology; basal cell carcinoma; confocal microscopy; image interpretation, computer-assisted; microscopy, confocal; skin neoplasms; pathology; skin tumor; feasibility study; computer assisted diagnosis; feasibility studies; carcinoma, basal cell; mohs surgery; chemosurgery; surgery, computer-assisted; computer assisted surgery
Journal Title: Journal of Biomedical Optics
Volume: 13
Issue: 5
ISSN: 1083-3668
Publisher: SPIE  
Date Published: 2008-01-01
Start Page: 054001
Language: English
PUBMED: 19021381
PROVIDER: scopus
PMCID: PMC2662759
DOI: 10.1117/1.2981828
DOI/URL:
Notes: --- - "Cited By (since 1996): 17" - "Export Date: 17 November 2011" - "Source: Scopus"
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MSK Authors
  1. Kishwer S Nehal
    245 Nehal
  2. Daniel S Gareau
    23 Gareau
  3. Yongbiao Li
    20 Li