Fluorescence confocal mosaicing microscopy of basal cell carcinomas ex vivo: Demonstration of rapid surgical pathology with high sensitivity and specificity Conference Paper

  

Authors:	Gareau, D. S.; Karen, J.; Dusza, S. W.; Tudisco, M.; Nehal, K. S.; Rajadhyaksha, M.
Editors:	Mahadevan-Jansen, A.; Vo-Dinh, T.; Grundfest, W. S.
Title:	Fluorescence confocal mosaicing microscopy of basal cell carcinomas ex vivo: Demonstration of rapid surgical pathology with high sensitivity and specificity
Conference Title:	Advanced Biomedical and Clinical Diagnostic Systems VII
Abstract:	Mohs surgery, for the precise removal of basal cell carcinomas (BCCs), consists of a series of excisions guided by the surgeon's examination of the frozen histology of the previous excision. The histology reveals atypical nuclear morphology, identifying cancer. The preparation of frozen histology is accurate but labor-intensive and slow. Nuclear pathology can be achieved by staining with acridine orange (1 mM, 20 s) BCCs in Mohs surgical skin excisions within 5-9 minutes, compared to 20-45 for frozen histology. For clinical utility, images must have high contrast and high resolution. We report tumor contrast of 10-100 fold over the background dermis and submicron (diffraction limited) resolution over a cm field of view. BCCs were detected with an overall sensitivity of 96.6%, specificity of 89.2%, positive predictive value of 93.0% and negative predictive value of 94.7%. The technique was therefore accurate for normal tissue as well as tumor. We conclude that fluorescence confocal mosaicing serves as a sensitive and rapid pathological tool. Beyond Mohs surgery, this technology may be extended to suit other pathological needs with the development of new contrast agents. The technique reported here accurately detects all subtypes of BCC in skin excisions, including the large nodular, small micronodular, and tiny sclerodermaform tumors. However, this technique may be applicable to imaging tissue that is larger, more irregular and of various mechanical compliances with further engineering of the tissue mounting and staging mechanisms. © 2009 SPIE.
Keywords:	basal cell carcinoma; fluorescence; pathology; histology; skin; tumors; surgery; ex-vivo; acridine orange; diffraction limited; clinical utility; contrast agent; field of views; high contrast; high resolution; high sensitivity; imaging tissues; mechanical compliance; mohs surgery; mosaicing; negative predictive value; normal tissue; nuclear morphology; positive predictive values; submicron; surgical pathology; biological radiation effects; tissue engineering
Journal Title	Proceedings of SPIE
Volume:	7169
Conference Dates:	2009 Jan 25-26
Conference Location:	San Jose, CA
ISBN:	0277-786X
Publisher:	SPIE
Date Published:	2009-01-01
Start Page:	7169 0Y
Language:	English
DOI:	10.1117/12.809445
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-66249098107&partnerID=40&md5=b08b0a1b279ee1549455f4bbfe9612d0
Notes:	--- - Progress in Biomedical Optics and Imaging - Proceedings of SPIE - "Export Date: 30 November 2010" - "Art. No.: 71690Y" - "CODEN: PSISD" - "Source: Scopus"

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