Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Br J Dermatol. 2010 Dec;163(6):1218-28. doi: 10.1111/j.1365-2133.2010.10063.x.
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 (AlCl(3)) enhances contrast in RCM images by brightening nuclei.
To investigate feasibility of RCM imaging of shave biopsy wounds using AlCl(3) as a contrast agent.
AlCl(3) 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.
For 35% AlCl(3) , 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.
RCM imaging of shave biopsy wounds is feasible and demonstrates the future possibility of intraoperative mapping in surgical wounds.
反射共聚焦显微镜（RCM）以细胞分辨率观察皮肤，已显示出在体内诊断非黑素瘤皮肤癌的作用。氯化铝（AlCl（3））的局部应用通过使细胞核变亮增强了 RCM 图像的对比度。
研究使用 AlCl（3）作为对比剂对 shave 活检伤口进行 RCM 成像的可行性。
在离体组织上优化了 AlCl（3）的浓度与浸泡时间，以优化其染色效果。在接受 shave 活检的患者中测试了 RCM 成像方案。对 RCM 图像进行了回顾性分析，并与相应的组织病理学进行了比较。
对于 35%的 AlCl（3），常规用于临床止血，确定了最短的浸泡时间为 1 分钟。通过改变深度，我们在 RCM 镶嵌图像上识别出三种一致的边缘模式：表皮边缘、周围真皮边缘和深部真皮边缘。基底细胞癌的肿瘤岛位于周围或深部真皮边缘，在组织病理学上与成簇的肿瘤性基底样细胞相对应。在鳞状细胞癌中，表皮边缘出现非典型鹅卵石或蜂窝状模式，与延伸至活检边缘的不典型角质形成细胞增生相对应。
shave 活检伤口的 RCM 成像可行，并展示了在手术伤口中进行术中定位的未来可能性。
