Grizzetti L, Kuonen F
Department of Dermatology and Venereology, Hôpital de Beaumont Lausanne University Hospital Center Lausanne Switzerland.
Skin Health Dis. 2022 Jan 10;2(2):e91. doi: 10.1002/ski2.91. eCollection 2022 Jun.
The assessment of surgical margins is mandatory to prevent local recurrence or distant dissemination of skin cancers. Histological examination of haematoxylin and eosin (H&E)-stained slides from paraffin-embedded or frozen samples is the gold standard for margin assessment, but is a time-consuming procedure. Ex vivo confocal laser scanning microscopy (CLSM) is an upcoming technique that scans unfixed fresh tissue rapidly, allowing fast per-operative margin assessment.
Here, we propose to assess the efficiency of a new ex vivo confocal microscope for the per-operative assessment of surgical margins.
We analyzed 16 biopsies and 93 surgical specimens of basal cell and squamous cell carcinomas by ex vivo CLSM using Histolog® Scanner V2. Surgical specimens included fusiform excisions, slow-Mohs peripheral and deep compartments, and Mohs excisions. The time required from surgical excision to image analysis was recorded and the quality of the images obtained for each specimen assessed. The presence or absence of tumour was estimated based on ex vivo CLSM images and compared with conventional H&E-stained sections from paraffin-embedded or frozen (Mohs) specimens.
Mean time for specimen processing using Histolog Scanner was 5.1 ± 3.4 min. We obtained 89% of high quality images. Mean time for confocal image analysis was 1 ± 0.76 min. The diagnostic sensitivity and specificity for ex vivo CLSM compared to classical H&E procedures were respectively 93% and 100% when performed on tumour biopsies. The overall sensitivity and specificity for ex vivo CLSM for margin assessment compared to classical H&E procedures were respectively 61.5% and 95%, with variations depending on the type of tumour or surgical specimen analyzed. In particular, we obtained 80% sensitivity and 100% specificity for the assessment of BCC surgical margins.
Our data suggest that ex vivo CLSM using Histolog® Scanner V2 could be a valid help for surgeons for a fast and accurate per-operative margin analysis.
评估手术切缘对于预防皮肤癌的局部复发或远处播散至关重要。对石蜡包埋或冷冻样本进行苏木精和伊红（H&E）染色玻片的组织学检查是切缘评估的金标准，但这是一个耗时的过程。离体共聚焦激光扫描显微镜（CLSM）是一种新兴技术，可快速扫描未固定的新鲜组织，从而实现术中快速切缘评估。
在此，我们旨在评估一种新型离体共聚焦显微镜用于术中手术切缘评估的效率。
我们使用Histolog® Scanner V2通过离体CLSM分析了16例基底细胞癌和鳞状细胞癌的活检样本以及93例手术标本。手术标本包括梭形切除术、慢速莫氏手术的周边和深部组织以及莫氏切除术。记录从手术切除到图像分析所需的时间，并评估每个标本获得的图像质量。根据离体CLSM图像估计肿瘤的有无，并与石蜡包埋或冷冻（莫氏）标本的传统H&E染色切片进行比较。
使用Histolog Scanner处理标本的平均时间为5.1±3.4分钟。我们获得了89%的高质量图像。共聚焦图像分析的平均时间为1±0.76分钟。在肿瘤活检中，与传统H&E程序相比，离体CLSM的诊断敏感性和特异性分别为93%和100%。与传统H&E程序相比，离体CLSM用于切缘评估的总体敏感性和特异性分别为61.5%和95%，具体数值因所分析的肿瘤类型或手术标本而异。特别是，我们在评估基底细胞癌手术切缘时获得了80%的敏感性和100%的特异性。
我们的数据表明，使用Histolog® Scanner V2的离体CLSM可为外科医生进行快速准确的术中切缘分析提供有效帮助。
