反射式共聚焦激光扫描显微镜在基底细胞癌术后随访中的应用

目的：明确反射式共聚焦激光扫描显微镜检测在基底细胞癌术后随访中的应用价值。方法：对22例基底细胞癌患者术后1个月、3个月、6个月、12个月分别进行手术部位的RCM扫描检测，RCM发现肿瘤组织的患者行组织病理学检查。结果：22例患者行RCM规律复查，其中4例于术后1个月复查发现肿瘤细胞，1例术后3个月复查发现肿瘤细胞，1例于术后半年发现肿瘤组织。6例患者均再次病理学检查诊断明确基底细胞癌，其余16例随访12个月于手术部位未见复发。结论：RCM在基底细胞癌术后随访中具有重要的应用价值。     

体外反射式共聚焦扫描显微镜在结节型基底细胞癌诊断中的应用

目的观察基底细胞癌的反射式共聚焦扫描显微镜(皮肤CT)影像特征,探讨其在诊断基底细胞癌中的应用价值。方法对在我科就诊的42例临床上初步考虑基底细胞癌的患者,在患者采用皮肤CT检查,后取该处皮损进行组织病理学检查,并将两者作比对,从而对基底细胞癌的皮肤CT影像特征进行归纳总结。结果皮损处皮肤CT的特征:瘤细胞聚集成岛屿状或条索状分布,由密集的异型肿瘤细胞构成,周边细胞呈栅栏状排列。瘤细胞团内可见明亮的高折光性树枝状细胞。与HE染色诊断具有100%的符合率。结论基底细胞癌在皮肤CT成像中具有明显的特点,为无创诊断基底细胞癌提供了新的方法 。     

基底细胞癌的共聚焦激光扫描显微镜图像特征

目的探讨基底细胞癌(BCC)的共聚焦激光扫描显微镜(CLSM)图像特征。方法对12例经病理活检确诊的BCC患者进行CLSM检测,分析BCC的CLSM图像特征。结果 12例患者皮损部位的表皮和/或真皮中均可见高折光细胞团块,其细胞拉长,呈轮辐状排列,8例瘤体内及其周边可见以单一核细胞为主的炎症细胞浸润,11例在瘤体内及其周边可见血管明显扭曲扩张。结论表皮及真皮内高折光细胞团块,其细胞拉长呈轮辐状排列是基底细胞癌的特征性CLSM图像特征,可作为CLSM诊断基底细胞癌的重要依据。     

反射式共聚焦显微镜在常见皮肤恶性肿瘤中的应用

反射式共聚焦显微镜是最新出现的临床辅助诊断技术。它在皮肤科恶性肿瘤的应用是目前研究热点。实时、无创、高分辨率的特点使其适用于皮肤科恶性肿瘤的诊断、治疗和随访中。对其在黑素瘤、基底细胞癌、鳞状细胞癌诊断中的应用进行了综述。     

反射式共聚焦显微镜在疥疮诊断中的应用

正疥疮,俗称"闹疮",是由疥螨在皮肤表皮内引起的接触性传染性皮肤病[1],易发生于集体生活的学校、军营或务工人员。由于瘙痒难耐,夜间更甚,容易发生继发反应,如抓痕、血痂、湿疹样变、脓疱、色沉等,许多患者就诊时症状并不典型而易误诊。反射式共聚焦显微镜(reflectance confocal microscopy, RCM)是一种新型原位、实时、动态的检测仪器[2,3],其扫描深度从皮肤表面直至真皮乳头及浅层约300 μm,已被用于评估多种     

反射式共聚焦显微镜辅助诊断疥疮

患儿男,8岁。双手及腋下红色丘疹,阴囊结节伴瘙痒3个月。皮肤科检查：双手背、指间、掌纹间隙及腕部屈侧可见粟粒大暗红色丘疹,双侧腋下及股部可见豆粒大红色丘疹,阴囊和阴茎可见多发绿豆至黄豆大暗红色结节。反射式共聚焦显微镜下可见隧道、疥螨虫体、虫卵及粪便。诊断：疥疮。     

反射式共聚焦显微镜在头皮银屑病早期诊断中的应用

目的:探讨头皮银屑病的反射式共聚焦显微镜(RCM,简称皮肤CT)图像特征,分析皮肤CT在其诊治中的临床意义。方法:选取临床拟诊为头皮银屑病患者55例,分别行皮肤CT扫描检查和组织病理检查,分析皮肤CT对头皮银屑病的特征表现及诊断准确度。结果:头皮银屑病皮肤CT的主要特征为角化不全,Munro微脓肿,真皮乳头上顶、真皮乳头密度增加、规则排列,真皮乳头内明显迂曲扩张充血的血管。皮肤CT诊断银屑病47例(85.5%),通过病理检查确诊银屑病49例(89.1%),以病理检查为金标准,皮肤CT检查诊断的灵敏度为91.8%(45/49),特异度为66.7%(4/6),准确度89.1%(49/55),误诊率33.3%(2/6),漏诊率8.2%(4/49),Youden指数为0.585,Kappa值为0.510(P<0.05)。结论:RCM(皮肤CT)扫描检查对头皮银屑病具有辅助诊断及提供鉴别诊断线索的作用,值得临床推广。     

反射式共聚焦显微镜在感染性皮肤病中的应用

反射式共聚焦显微镜(RCM),是皮肤科新兴的诊断手段,在很多疾病的应用方面日趋成熟。RCM目前已经广泛应用于皮肤肿瘤和色素皮肤疾病的诊疗。本研究总结了多种常见感染性皮肤病RCM表现:疱疹性皮肤病,见表皮水疱内高折光圆盘细胞;扁平疣为颗粒层及棘层上部细胞呈同心圆样排列;玫瑰痤疮毛囊内见蠕形螨过度繁殖;手足癣RCM真菌菌丝检出率较高;手足口病见表皮内密集多房性小水疱等。希望RCM能为常见感染性皮肤病的诊断及鉴别诊断提供更多帮助。     

反射式共聚焦显微镜在幼年黄色肉芽肿诊断中的应用

目的:探讨幼年黄色肉芽肿在反射式共聚焦显微镜(RCM)下的特征,并分析其与组织病理检查诊断的一致性。方法:选取2016年1月—2016年12月皮肤科门诊临床拟诊为幼年黄色肉芽肿的患者,采集RCM图像后,行常规组织病理检查。结果:所有RCM拟诊为幼年黄色肉芽肿的疑似患者,经组织病理检查均证实为幼年黄色肉芽肿。该病皮损在RCM下的特征为表皮突消失或增宽,真皮浅层可见大量较大体积、中高折光及不规则形态细胞浸润;部分细胞簇集融合,形成散在分布的、明亮的高折光环状结构。结论:幼年黄色肉芽肿在RCM下具有特征性表现,可作为早期辅助诊断及鉴别诊断的有效方法。     

反射式共聚焦扫描显微镜在原发性皮肤淀粉样变诊断中的应用

目的 探讨原发性皮肤淀粉样变在反射式共聚焦扫描显微镜(RCM)下的主要敏感图像特征.方法 收集17例RCM下疑似原发性皮肤淀粉样变的病例,取该处皮损进行组织病理检查并结晶紫染色,记录并分析图像特征.结果 皮损处RCM主要敏感图像特征:角化过度,棘层轻度增厚,个别真皮乳头内见中低折光团块样物质,浅层血管周围可见嗜黑素细胞...     

Effectiveness and limitations of reflectance confocal microscopy in detecting persistence of basal cell carcinomas: a preliminary study

Background/Objectives: Reflectance confocal microscopy (RCM) can accurately and non‐invasively diagnose basal cell carcinoma (BCC). The use of RCM in assessing responses to saucerization or curettage and cautery of BCC has not been established. The aim of the present study was to expound the usefulness of RCM in assessing treatment responses of BCC to saucerization or curettage and cautery 8–12 weeks after treatment. Methods: Eight sequential patients, with 11 superficial BCCs, were recruited. Lesions were evaluated clinically and dermoscopically. Three operators performed RCM imaging for each BCC at baseline and 8–12 weeks after treatment. Diagnostic criteria for RCM diagnosis included streaming of basal cells and the presence of cord‐like structures and horizontal vessels. Results were compared against histopathology. Difficulties in establishing tumour clearance were identified and the effectiveness of RCM in assessing the response to treatment was explored. Results: At baseline, all lesions were consistent with superficial BCC. At 8–12 weeks after treatment, RCM correctly diagnosed 10 of 11 lesions as tumour free. Furthermore, RCM was reliable across operators of variable experience and the findings were confirmed histopathologically. Limitations were identified, but appeared to be related to operator experience. Conclusion: The diagnosis of BCC was straightforward and reliable in the present study. Thus, RCM appears useful in assessing the early treatment response of superficial BCC treated with saucerization or curettage and cautery despite operator‐dependant limitations.     

Detection of basal cell carcinomas in Mohs excisions with fluorescence confocal mosaicing microscopy

Background High‐resolution real‐time imaging of human skin is possible with a confocal microscope either in vivo or in freshly excised tissue ex vivo. Nuclear and cellular morphology is observed in thin optical sections, similar to that in conventional histology. Contrast agents such as acridine orange in fluorescence and acetic acid in reflectance have been used in ex vivo imaging to enhance nuclear contrast. Objectives To evaluate the sensitivity and specificity of ex vivo real‐time imaging with fluorescence confocal mosaicing microscopy, using acridine orange, for the detection of residual basal cell carcinoma (BCC) in Mohs fresh tissue excisions. Methods Forty‐eight discarded skin excisions were collected following completion of Mohs surgery, consisting of excisions with and without residual BCC of all major subtypes. The tissue was stained with acridine orange and imaged with a fluorescent confocal mosaicing microscope. Confocal mosaics were matched to the corresponding haematoxylin and eosin‐stained Mohs frozen sections. Each mosaic was divided into subsections, resulting in 149 submosaics for study. Two Mohs surgeons, who were blinded to the cases, independently assessed confocal submosaics and recorded the presence or absence of BCC, location, and histological subtype(s). Assessment of confocal mosaics was by comparison with corresponding Mohs surgery maps. Results The overall sensitivity and specificity of detecting residual BCC was 96·6% and 89·2%, respectively. The positive predictive value was 92·3% and the negative predictive value 94·7%. Very good correlation was observed between confocal mosaics and matched Mohs frozen sections for benign and malignant skin structures, overall tumour burden and location, and identification of all major histological subtypes of BCC. Conclusions Fluorescent confocal mosaicing microscopy using acridine orange enables detection of residual BCC of all subtypes in Mohs fresh tissue excisions with high accuracy. This observation is an important step towards the long‐term clinical goal of using a noninvasive imaging modality for potential real‐time surgical pathology‐at‐the‐bedside for skin and other tissues.     

反射式共聚焦显微镜在筛检面部难辨认癣的临床应用

目的:评价反射式共聚焦显微镜(RCM)在诊断浅部真菌病中的应用价值。方法:对46例临床诊断为面部湿疹等但不排除难辨认癣的患者,进行RCM扫描及光学显微镜检查,观察镜下菌丝特征,并与真菌图片相比较。结果:RCM诊断难辨认癣42例(阳性率91.12%),真菌涂片检查阳性40例(阳性率87.83%),差异无统计学意义(P0.05),二者结果具有较好的一致性。结论:RCM是筛检难辨认癣与鉴别皮炎湿疹等皮肤病很好的辅助工具。     

First experiences using reflectance confocal microscopy on equivocal skin lesions in Queensland

Background/Objectives: Reflectance confocal microscopy (RCM) is a non‐invasive method of imaging human skin in vivo. The purpose of this study was to observe the experience of using RCM on equivocal skin lesions in a tertiary clinical setting in Queensland. Methods: Fifty equivocal lesions on 42 patients were imaged using a reflectance confocal microscope immediately prior to being excised. The images were then analysed blind to the histopathological diagnosis. The experience and problems encountered when using RCM on skin lesions for the first time was also observed. Results: On RCM analysis 12/13 melanomas (92.3% sensitivity, 75% specificity), 19/22 benign naevi (86% sensitivity, 95% specificity), 6/9 basal cell carcinomas (66.7% sensitivity, 100% specificity)and 6/6 squamous cell carcinomas and its precursors (100% sensitivity, 75% specificity) were diagnosed correctly when using histology as the gold standard. We identified three common problems that affected image quality: object artefacts; positioning artefacts; and movement artefacts. Conclusions: Using simple techniques we found that common RCM features were readily identifiable and common artefacts could be minimized, making RCM a useful tool to aid the diagnosis of equivocal skin lesions in a clinical setting.     

Investigation of basal cell carcionoma by confocal laser scanning microscopy in vivo

Background/purpose In vivo confocal laser scanning microscopy (CLSM) allows to study human skin up to 200 µm deep non-invasively. Aim of this study was to investigate basal cell carcinoma (BCC) using in vivo CLSM, and to compare the micromorphologic features of BCC with uninvolved skin.
Methods Twelve patients with histological diagnosis of BCC referred to our department for tumor excision were investigated on the lesion(s) and on clinically uninvolved sites preoperatively by in vivo CLSM using the Vivascope 1000 (Lucid Inc., Rochester, USA). The images were compared to histological examinations of the excised tissue.
Results Typical changes in vasculature such as increase in number and diameter of the blood vessels, loss of the vascular architecture, parallelly and horizontally orientated vessels, and accumulation and rolling phenomena of bright reflecting cells of 11.88 ± 1.75 µm in diameter along the vessel wall were observed in all BCCs. The tumor stroma of the BCCs showed a strong reflectance mainly due to numerous bundles of collagen fibers encoating dark, cell-rich areas of tumor parenchym. In five patients, slim basaloid cells with relatively large, elongated dark nuclei were observed in the periphery of the tumor parenchym. In the fibrosing type of BCC, curled bundles of collagen with large cells represented the tumor stroma.
Conclusions BCC can be investigated by CLSM and provide typical features. Besides the tumor parenchym and stroma, typical changes in vasculature seem to be a sensitive criteria for BCC and may in future help in diagnosing BCC by CLSM as well as in assessing the margins of large tumors. We suggest that CLSM is a promising non-invasive tool for the diagnostics of BCC and the assessment of tumor margins prior to surgery.