Presurgical evaluation of basal cell carcinoma using combined reflectance confocal microscopy–optical coherence tomography: A prospective study

Aleissa, Saud; Navarrete‐Dechent, Cristián; Córdova, Miguel; Sahu, Aditi; Dusza, Stephen W.; Phillips, William T.; Rossi, Anthony; Lee, Erica; Nehal, Kishwer S.

doi:10.1016/j.jaad.2019.10.028

Cited by 30 publications

(29 citation statements)

References 26 publications

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“…More recently, RCM and OCT have been combined into a single device for integrated RCMeOCT imaging to improve the comprehensive evaluation of BCC. This combined approach synergistically enhances the RCM lateral resolution with the OCT depth evaluation (Aleissa et al, 2020).…”

Section: Reflectance Confocal Microscopy and Optical Coherence Tomogrmentioning

confidence: 99%

“…Clinical applications of RCM and OCT. A subset of patients with BCC can present to surgeons without clinically evident lesions after a biopsy. In these cases, studies have shown that up to 2 of 3 patients will have residual microscopic BCC (Aleissa et al, 2020; Navarrete-Dechent et al, 2019a). One study found that RCM correctly detected the presence of residual BCC before MMS with a sensitivity of 92.8% and a specificity of 68.4%.…”

Section: Reflectance Confocal Microscopy and Optical Coherence Tomogrmentioning

confidence: 99%

“…After excluding aggressive subtypes from the analysis, the negative predictive value was 100% (Navarrete-Dechent et al, 2019a). The evaluation of similar cases of BCC using an integrated RCMeOCT imaging approach detected the deeper component in aggressive subtypes (Aleissa et al, 2020). The addition of OCT enabled evaluation to a depth of 1,000 mm, overcoming the inherent depth limitation of RCM.…”

Section: Reflectance Confocal Microscopy and Optical Coherence Tomogrmentioning

confidence: 99%

“…The main limitation of these treatments is the lack of histopathologic confirmation of tumor clearance and the related higher recurrence rates when compared with surgical modalities. The combined RCMeOCT device has been shown to accurately estimate BCC depth when compared with histopathology, and it can guide clinical decision making (Aleissa et al, 2020). For example, imiquimod has been shown to be more effective in treating superficial BCC than deeper subtypes.…”

Section: Noninvasive Imaging As An Aid For Nonsurgical Treatment Modamentioning

confidence: 99%

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Perioperative Noninvasive Optical Imaging: A Changing Paradigm for Management of Keratinocyte Carcinomas

Navarrete‐Dechent

Rajadhyaksha

Nehal

2020

Journal of Investigative Dermatology

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Section: Reflectance Confocal Microscopy and Optical Coherence Tomogrmentioning

confidence: 99%

Section: Reflectance Confocal Microscopy and Optical Coherence Tomogrmentioning

confidence: 99%

Section: Reflectance Confocal Microscopy and Optical Coherence Tomogrmentioning

confidence: 99%

Section: Noninvasive Imaging As An Aid For Nonsurgical Treatment Modamentioning

confidence: 99%

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Perioperative Noninvasive Optical Imaging: A Changing Paradigm for Management of Keratinocyte Carcinomas

Navarrete‐Dechent

Rajadhyaksha

Nehal

2020

Journal of Investigative Dermatology

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“…[22][23][24][25] However, OCT can reliably distinguish normal skin from tumor; therefore, with its larger FOV, OCT enables more comprehensive assessment of tumor depth and/or margins. 22,[24][25][26][27][28] We have previously shown that a handheld integrated (originally called combined) RCM-OCT device with the RCM FOV captured in center of the co-registered OCT FOV ( Figure 1) allows for more accurate BCC diagnosis as the operator can see the tumor at cellularlevel resolution while, in the same location, assessing the lesion's depth and three-dimensional (3D) architecture. 25,29 By moving this handheld device over the skin, integrated RCM-OCT allows for examination of all F I G U R E 1 Three-dimensional (3D) volume of skin imaged by the handheld integrated reflectance confocal microscopy-optical coherence tomography (RCM-OCT) device and image capture method used for the study protocol.…”

Section: Introductionmentioning

confidence: 99%

Angulated small nests and cords: Key diagnostic histopathologic features of infiltrative basal cell carcinoma can be identified using integrated reflectance confocal microscopy‐optical coherence tomography

et al. 2020

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Background: Accurate basal cell carcinoma (BCC) subtyping is requisite for appropriate management, but non-representative sampling occurs in 18% to 25% of biopsies. By enabling non-invasive diagnosis and more comprehensive sampling, integrated reflectance confocal microscopy-optical coherence tomography (RCM-OCT) may improve the accuracy of BCC subtyping and subsequent management. We evaluated RCM-OCT images and histopathology slides for the presence of two key features, angulation and small nests and cords, and calculated (a) sensitivity and specificity of these features, combined and individually, for identifying an infiltrative BCC subtype and (b) agreement across modalities. Methods: Thirty-three RCM-OCT-imaged, histopathologically-proven BCCs (17 superficial and/or nodular; 16 containing an infiltrative component) were evaluated. Results: The presence of angulation or small nests and cords was sufficient to identify infiltrative BCC on RCM-OCT with 100% sensitivity and 82% specificity, similar to histopathology (100% sensitivity, 88% specificity, kappa = 0.82). When both features were present, the sensitivity for identifying infiltrative BCC was 100% using either modality and specificity was 88% on RCM-OCT vs 94% on histopathology, indicating nearperfect agreement between non-invasive and invasive diagnostic modalities (kappa = 0.94). Melissa Gill and Aditi Sahu contributed equally to this work and should be considered joint first authors. Milind Rajadhyaksha and Chih-Shan J.

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Ex vivo assessment of basal cell carcinoma surgical margins in Mohs surgery by autofluorescence‐Raman spectroscopy: A pilot study

Boitor,

Varma,

Sharma

et al. 2023

JEADV Clinical Practice

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BackgroundAutofluorescence (AF)‐Raman spectroscopy is a technology that can detect tumour tissue in surgically excised skin specimens. The technique does not require tissue fixation, staining, labelling or sectioning, and provides quantitative diagnosis maps within 30 min.ObjectivesTo explore the clinical application of AF‐Raman microscopy to detect residual basal cell carcinoma (BCC) positive margins in ex vivo skin specimens excised during real‐time Mohs surgery. To investigate the ability to analyse skin specimens from different parts of the head‐and‐neck areas and detect nodular, infiltrative and superficial BCC.MethodsFifty Mohs tissue layers (50 patients) were investigated: 27 split samples (two halves) and 23 full‐face samples. The AF‐Raman results were compared to frozen section histology, carried out intraoperatively by the Mohs surgeon and postoperatively by dermatopathologists. The latter was used as the standard of reference.ResultsThe AF‐Raman analysis was completed within the target time of 30 min and was able to detect all subtypes of BCC. For the split specimens, the AF‐Raman analysis covered 97% of the specimen surface area and detected eight out of nine BCC positive layers (similar to Mohs surgeons). For the full‐face specimens, poorer contact between tissue and cassette coverslip led to lower coverage of the specimen surface area (92%), decreasing the detection rate (four out of six positives for BCC).ConclusionsThese preliminary results, in particular for the split specimens, demonstrate the feasibility of AF‐Raman microscopy for rapid assessment of Mohs layers for BCC presence. However, for full‐face specimens, further work is required to improve the contact between the tissue and the coverslip to increase sensitivity.

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Presurgical evaluation of basal cell carcinoma using combined reflectance confocal microscopy–optical coherence tomography: A prospective study

Cited by 30 publications

References 26 publications

Perioperative Noninvasive Optical Imaging: A Changing Paradigm for Management of Keratinocyte Carcinomas

Perioperative Noninvasive Optical Imaging: A Changing Paradigm for Management of Keratinocyte Carcinomas

Angulated small nests and cords: Key diagnostic histopathologic features of infiltrative basal cell carcinoma can be identified using integrated reflectance confocal microscopy‐optical coherence tomography

Ex vivo assessment of basal cell carcinoma surgical margins in Mohs surgery by autofluorescence‐Raman spectroscopy: A pilot study

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