Confocal laser scanning microscopy--evaluation of native tissue sections in micrographic surgery

Area of Science:

• Dermatology
• Surgical Pathology
• Medical Imaging

Background:

• Micrographic surgery is a standard procedure for basal cell carcinoma (BCC) excision, particularly in cosmetically sensitive or functionally important areas.
• Frozen histopathology is a time-intensive component of micrographic surgery, necessitating faster margin assessment techniques.
• Ex vivo confocal laser scanning microscopy (CM) offers potential for real-time tissue margin evaluation.

Purpose of the Study:

• To evaluate the utility of ex vivo confocal laser scanning microscopy (CM) for assessing tumor margins in basal cell carcinomas (BCCs) excised via micrographic surgery.
• To compare the diagnostic accuracy of CM with conventional light microscopy for BCC margin identification.
• To determine if CM can accelerate the micrographic surgery workflow.

Main Methods:

• Fifty-two excised basal cell carcinoma specimens were examined using ex vivo confocal laser scanning microscopy (CM).
• Tissues were treated with 10% citric acid for contrast enhancement prior to CM analysis.
• CM findings were compared against conventional light microscopy results for concordance.

Main Results:

• Morphological features observed under CM closely corresponded to those seen with conventional light microscopy.
• A high degree of consistency (84.6%) was found between confocal assessment and light microscopy findings.
• CM can potentially expedite micrographic surgery when tumors are clearly identifiable; however, negative findings require conventional confirmation.

Conclusions:

• Ex vivo confocal laser scanning microscopy (CM) demonstrates potential as an adjunct tool to accelerate micrographic surgery for basal cell carcinoma.
• Current limitations include inconsistent image quality, hindering reliable detection of small tumor nests, and necessitating further research.
• Optimization of sample handling and contrast enhancement techniques is crucial for broader clinical acceptance of CM in micrographic surgery.