Frozen-Section Tissue Processing in Mohs Surgery

Aslam, Arif; Aasi, Sumaira Z.

doi:10.1097/dss.0000000000002260

Cited by 24 publications

(25 citation statements)

References 25 publications

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“…We noted that thicker tissue specimens, which contained predominantly stiffer connective tissue (nose, lip), had a higher proportion of their surface area in poor contact with the cassette window (3.03% and 4.58%, respectively). Tissue sections rich in collagen are known to be challenging to flatten in frozen section histopathology [ 22 ]. It has been suggested that such tissue specimens are best flattened against a microscope slide to ensure that as much of the tissue margin is found within a single plane as possible [ 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…While processing of adipose tissue for frozen section histopathology can be challenging due to the lower temperatures needed to freeze such tissue, often resulting in excessive tissue trimming [ 22 ], this tissue type poses no difficulties for the Fast Raman measurements. Adipose tissue is easy to flatten against the cassette window and has very low superficial blood.…”

Section: Resultsmentioning

confidence: 99%

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Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Boitor

Wolf

Weesie

et al. 2021

Biomed. Opt. Express

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We present the first clinical integration of a prototype device based on integrated auto-fluorescence imaging and Raman spectroscopy (Fast Raman device) for intra-operative assessment of surgical margins during Mohs micrographic surgery of basal cell carcinoma (BCC). Fresh skin specimens from 112 patients were used to optimise the tissue pre-processing and the Fast Raman algorithms to enable an analysis of complete Mohs layers within 30 minutes. The optimisation allowed >95% of the resection surface area to be investigated (including the deep and epidermal margins). The Fast Raman device was then used to analyse skin layers excised from the most relevant anatomical sites (nose, temple, eyelid, cheek, forehead, eyebrow and lip) and to detect the three main types of BCC (nodular, superficial and infiltrative). These results suggest that the Fast Raman technique is a promising tool to provide an objective diagnosis “tumour clear yes/no” during Mohs surgery of BCC. This clinical integration study is a key step towards a larger scale diagnosis test accuracy study to reliably determine the sensitivity and specificity in a clinical setting.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Boitor

Wolf

Weesie

et al. 2021

Biomed. Opt. Express

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“…In this study, 7 baseline patients' characteristics, recurrence and clinical outcomes were not significantly different between MMS techniques. Comparing both techniques, in terms of performance and implementation in daily practice, frozen MMS (or direct/fresh Mohs) has the main advantage of reducing surgical times as it implies immediate microscopic examination of surgical margins 22,23 and completion of surgery with definite wound closure at the same surgical process 24‐26 …”

Section: Resultsmentioning

confidence: 99%

Mohs micrographic surgery in dermatofibrosarcoma protuberans: Rate and risk factors for recurrence in a prospective cohort study from the Spanish Registry of Mohs Surgery (REGESMOHS) and review of the literature

Nieto‐Benito

Ciudad-Blanco

Sanmartín-Jiménez

et al. 2021

Experimental Dermatology

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Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person‐years (95% IC = 0.36–2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow‐up time was 28.6 months with 414 patient‐years of follow‐up. In conclusion, we found an overall low recurrence rate of DFSP treated with MMS. None of the studied risk factors, including MMS techniques, was associated with higher risk for recurrence.

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“…Three-dimensional tissue modeling prior to histological assessment provides smart grossing recommendations while automating the report of tissue size and orientation 66 . We utilized photogrammetry techniques which triangulate image features across multiple viewpoints/images to 3D coordinates in order to generate a 3D model of the tissue.…”

Section: D Tissue Modeling and Grossing Recommendations In 3d Model Panementioning

confidence: 99%

ArcticAI: A Deep Learning Platform for Rapid and Accurate Histological Assessment of Intraoperative Tumor Margins

Levy

Davis

Chacko

et al. 2022

Preprint

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Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Radial sectioning of the resected tumor and surrounding tissue is the most common form of intra-operative and post-operative margin assessment. However, this technique samples only a tiny fraction of the available tissue and therefore may result in incomplete excision of the tumor, increasing the risk of recurrence and distant metastasis and decreasing survival. Repeat procedures, chemotherapy, and other resulting treatments pose significant morbidity, mortality, and fiscal costs for our healthcare system. Mohs Micrographic Surgery (MMS) is used for the removal of basal cell and squamous cell carcinoma utilizing frozen sections for real-time margin assessment while assessing 100% of the peripheral and deep margins, resulting in a recurrence rate of less than one percent. Real-time assessment in many tumor types is constrained by tissue size and complexity and the time to process tissue and evaluate slides while a patient is under general anesthesia. In this study, we developed an artificial intelligence (AI) platform, ArcticAI, which augments the surgical workflow to improve efficiency by reducing rate-limiting steps in tissue preprocessing and histological assessment through automated mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma (BCC) as a model system, the results demonstrate that ArcticAI can provide effective grossing recommendations, accurately identify tumor on histological sections, map tumor back onto the surgical resection map, and automate pathology report generation resulting in seamless communication between the surgical pathology laboratory and surgeon. AI-augmented-surgical excision workflows may make real-time margin assessment for the excision of more complex and challenging tumor types more accessible, leading to more streamlined and accurate tumor removal while increasing healthcare delivery efficiency.

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Frozen-Section Tissue Processing in Mohs Surgery

Cited by 24 publications

References 25 publications

Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Clinical integration of fast Raman spectroscopy for Mohs micrographic surgery of basal cell carcinoma

Mohs micrographic surgery in dermatofibrosarcoma protuberans: Rate and risk factors for recurrence in a prospective cohort study from the Spanish Registry of Mohs Surgery (REGESMOHS) and review of the literature

ArcticAI: A Deep Learning Platform for Rapid and Accurate Histological Assessment of Intraoperative Tumor Margins

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