RESUMO
Recent studies have demonstrated the ability of confocal fluorescence mosaicing microscopy to rapidly detect basal cell carcinomas (BCCs) directly in thick and fresh Mohs surgical excisions. Mosaics of confocal images display large areas of tissue with high resolution and magnification equivalent to 2x, which is the standard magnification when examining pathology. Comparison of mosaics to Mohs frozen histopathology was shown to be excellent for all types of BCCs. However, comparisons in the previous studies were visual and qualitative. In this work, we report the results of a semiquantitative preclinical study in which 45 confocal mosaics are blindly evaluated for the presence (or absence) of BCC tumor. The evaluations are made by two clinicians: a senior Mohs surgeon with prior expertise in interpreting confocal images, and a novice Mohs fellow with limited experience. The blinded evaluation is compared to the gold standard of frozen histopathology. BCCs are 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 results demonstrate the potential clinical utility of confocal mosaicing microscopy toward rapid surgical pathology at the bedside to expedite and guide surgery.
Assuntos
Carcinoma Basocelular/diagnóstico , Microscopia Confocal/métodos , Microscopia de Fluorescência/métodos , Neoplasias Cutâneas/diagnóstico , Laranja de Acridina/metabolismo , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Histocitoquímica , Humanos , Cirurgia de Mohs , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: Processing multiple tissue sections in large Mohs cases is time consuming and labor intensive. OBJECTIVE: To present innovative laboratory techniques to facilitate processing of large Mohs cases. METHODS: A method for processing a large dermatofibrosarcoma protuberans Mohs case is outlined. RESULTS: Modifications in tissue processing and equipment employed in a large Mohs case are presented. CONCLUSION: Innovative modifications to the standard Mohs laboratory technique can facilitate processing of large Mohs cases, resulting in high-quality, rapid frozen sections while optimizing efficiency.