Sierra Heidy, Yélamos Oriol, Cordova Miguel, Chen Chih-Shan Jason, Rajadhyaksha Milind
Memorial Sloan Kettering Cancer Center, Dermatology Service, New York, New York, United States.
Universitat de Barcelona, Hospital Clínic, Dermatology Department, Barcelona, Spain.
J Biomed Opt. 2017 Aug;22(8):1-13. doi: 10.1117/1.JBO.22.8.085005.
Laser ablation offers a procedure for precise, fast, and minimally invasive removal of superficial and early nodular basal cell carcinomas (BCCs). However, the lack of histopathological confirmation has been a limitation toward widespread use in the clinic. A reflectance confocal microscopy (RCM) imaging-guided approach offers cellular-level histopathology-like feedback directly on the patient, which may then guide and help improve the efficacy of the ablation procedure. Following an ex vivo benchtop study (reported in our earlier papers), we performed an initial study on 44 BCCs on 21 patients in vivo, using a pulsed erbium:ytterbium aluminum garnet laser and a contrast agent (aluminum chloride). In 10 lesions on six patients, the RCM imaging-guided detection of either presence of residual tumor or complete clearance was immediately confirmed with histopathology. Additionally, 34 BCCs on 15 patients were treated with RCM imaging-guided laser ablation, with immediate confirmation for clearance of tumor (no histopathology), followed by longer-term monitoring, currently in progress, with follow-up imaging (again, no histopathology) at 3, 6, and 18 months. Thus far, the imaging resolution appears to be sufficient and consistent for monitoring efficacy of ablation in the wound, both immediately postablation and subsequently during recovery. The efficacy results appear to be promising, with observed clearance in 19 cases of 22 cases with follow-ups ranging from 6 to 21 months. An additional 12 cases with 1 to 3 months of follow-ups has shown clearance of tumor but a longer follow-up time is required to establish conclusive results. Further instrumentation development will be necessary to cover larger areas with a more automatically controlled instrument for more uniform, faster, and deeper imaging of margins.
激光消融术为精确、快速且微创地切除浅表性和早期结节性基底细胞癌（BCC）提供了一种方法。然而，缺乏组织病理学确认一直是其在临床上广泛应用的一个限制因素。反射共聚焦显微镜（RCM）成像引导方法可直接在患者身上提供细胞水平的类似组织病理学的反馈，进而指导并有助于提高消融手术的疗效。在一项体外台式研究（在我们早期的论文中报道）之后，我们对21例患者身上的44个基底细胞癌进行了一项体内初步研究，使用脉冲铒：镱铝石榴石激光和一种造影剂（氯化铝）。在6例患者的10个病灶中，通过组织病理学立即证实了RCM成像引导下对残留肿瘤的存在或完全清除的检测。此外，对15例患者的34个基底细胞癌进行了RCM成像引导下的激光消融治疗，立即确认肿瘤清除（未进行组织病理学检查），随后进行正在进行的长期监测，在3个月、6个月和18个月时进行随访成像（同样未进行组织病理学检查）。到目前为止，成像分辨率似乎足以且一致地用于监测伤口消融术后即刻及随后恢复过程中的消融效果。疗效结果似乎很有前景，在22例随访时间为6至21个月的病例中，有19例观察到肿瘤清除。另外12例随访1至3个月的病例显示肿瘤已清除，但需要更长的随访时间来确定最终结果。为了用更自动控制的仪器覆盖更大的区域，以实现更均匀、更快且更深的边缘成像，还需要进一步的仪器开发。
