In vivo reflectance confocal microscopy of shave biopsy wounds: Feasibility of intraoperative mapping of cancer margins Journal Article

Authors: Scope, A.; Mahmood, U.; Gareau, D. S.; Kenkre, M.; Lieb, J. A.; Nehal, K. S.; Rajadhyaksha, M.
Article Title: In vivo reflectance confocal microscopy of shave biopsy wounds: Feasibility of intraoperative mapping of cancer margins
Abstract: Summary 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. © 2010 British Association of Dermatologists.
Keywords: adult; controlled study; human tissue; debridement; human cell; histopathology; squamous cell carcinoma; cell proliferation; reflectance confocal microscopy; basal cell carcinoma; confocal microscopy; image analysis; in vitro study; retrospective study; feasibility study; intraoperative period; biopsy technique; ex vivo study; hemostasis; surgical wound; immersion; aluminum chloride; shave biopsy wound
Journal Title: British Journal of Dermatology
Volume: 163
Issue: 6
ISSN: 0007-0963
Publisher: Blackwell Publishing  
Date Published: 2010-12-01
Start Page: 1218
End Page: 1228
Language: English
DOI: 10.1111/j.1365-2133.2010.10063.x
PROVIDER: scopus
PMCID: PMC2988110
PUBMED: 20874785
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: BJDEA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Kishwer S Nehal
    236 Nehal
  2. Jocelyn Ann Lieb
    12 Lieb
  3. Alon Scope
    123 Scope
  4. Daniel S Gareau
    23 Gareau
  5. Usman Ahmad Mahmood
    38 Mahmood