Vaišnorienė Ingrida, Rotomskis Ričardas, Kulvietis Vytautas, Eidukevičius Rimantas, Zalgevičienė Violeta, Laurinavičienė Aida, Venius Jonas, Didžiapetrienė Janina
National Cancer Institute, Vilnius, Lithuania.
National Cancer Institute, Vilnius, Lithuania; Biophotonics Group of Laser research Center, Vilnius University, Vilnius, Lithuania.
Medicina (Kaunas). 2014;50(4):209-15. doi: 10.1016/j.medici.2014.09.008. Epub 2014 Oct 1.
In vivo reflectance confocal microscopy (RCM) is a promising novel technology for non-invasive early diagnostics of cutaneous melanoma. However, the possibility to detect melanocytic atypia in nevi by means of in vivo RCM remains unknown. The aim of the study was to evaluate the significance of in vivo RCM features of melanocytic atypia for the diagnosis of melanocytic nevi, dysplastic nevi and cutaneous melanoma.
A total of 138 melanocytic skin lesions comprising 25 melanocytic nevi, 69 dysplastic nevi and 44 melanomas were analyzed by means of dermoscopy, in vivo RCM and routine histopathology. In vivo RCM images were analyzed for the arrangement of keratinocytes in epidermis, pagetoid cells and junctional melanocytic nests and correlated refractivity aspects of nests with histopathology.
Separately and all together taken the in vivo RCM features of melanocytic atypia were significant in differential diagnosis of benign and malignant melanocytic skin lesions, though none of the features was significant in discriminating nevi without cytologic atypia of dysplastic nevi. In vivo RCM feature of dense cell clusters corresponded with melanin containing nevomelanocytes on histopathology though exact correspondence of non-homogeneous and atypical sparse cell clusters remained questionable.
Nevus with histopathologically confirmed nevomelanocytic atypia (dysplastic nevus) could not be distinguished from nevus without atypia using analyzed in vivo RCM features of melanocytic atypia. More accurate diagnostics by means of in vivo RCM needs further investigation on reflectance of single and nested cutaneous melanocytes in benign and malignant skin lesions.
体内反射式共聚焦显微镜（RCM）是一种很有前景的用于皮肤黑色素瘤非侵入性早期诊断的新技术。然而，通过体内RCM检测痣中黑素细胞异型性的可能性尚不清楚。本研究的目的是评估黑素细胞异型性的体内RCM特征对黑素细胞痣、发育异常痣和皮肤黑色素瘤诊断的意义。
对138例黑素细胞性皮肤病变进行分析，包括25例黑素细胞痣、69例发育异常痣和44例黑色素瘤，采用皮肤镜检查、体内RCM检查和常规组织病理学检查。分析体内RCM图像中表皮角质形成细胞的排列、派杰样细胞和交界性黑素细胞巢，并将巢的相关折射特性与组织病理学进行关联。
黑素细胞异型性的体内RCM特征单独或综合起来在良性和恶性黑素细胞性皮肤病变的鉴别诊断中具有重要意义，尽管没有一个特征在区分无细胞学异型性的痣和发育异常痣方面具有显著意义。致密细胞簇的体内RCM特征在组织病理学上与含黑色素的痣黑素细胞相对应，尽管非均匀和非典型稀疏细胞簇的确切对应关系仍存在疑问。
使用分析的黑素细胞异型性的体内RCM特征，无法将组织病理学证实有痣黑素细胞异型性的痣（发育异常痣）与无异型性的痣区分开来。通过体内RCM进行更准确的诊断需要进一步研究良性和恶性皮肤病变中单个和巢状皮肤黑素细胞的反射情况。
