Dermatoscopia ex vivo: avaliação sincrônica entre o dermatologista e o dermatopatologista de lesões melanocíticas - Estudo prévio

Abstract

Resumo: A correlação clínico-patológica é fundamental para a precisão diagnóstica. Apesar de interdependentes, a dermatologia clínica e a dermatopatologia se distanciaram. Com o objetivo de minimizar essa distância, realizamos o exame dermatoscópico ex vivo. Realizamos a dermatoscopia comparativa in vivo e ex vivo seguida do mapeamento histopatológico. A dermatoscopia ex vivo permitiu identificar as mesmas estruturas, mas ocorreram alterações significativas das cores. Palavras-chave: Dermoscopia; Melanoma; Patologia Abstract: Clinicopathologic correlation is essential for diagnostic accuracy. Even though interdependent, dermatology and dermatopathology have become apart. In order to minimize this distance, we have performed ex vivo dermoscopic examinations. We performed comparative in vivo and ex vivo dermoscopy study followed by histopathological mapping. We observed that ex vivo dermoscopy identified the same structures visualized by the in vivo one, but with significant change of colors. 1 recentemente discutiram as condições que envolvem desde uma biópsia realizada pelo dermatologista até o diagnóstico final do dermopatologista. Eles assinalaram que poucos são os dermatologistas que examinam as lâminas dos pacientes; por outro lado, os dermopatologistas raramente veem a clínica. Além disso, a peça de biópsia é normalmente preparada por técnicos, restando ao patologista muito pouco da lesão original. Esses autores acreditam que a distância clínico-patológica pode levar a discordância diagnóstica, principalmente em câncer da pele.No sentido de reduzir essas discordâncias, propuseram que o dermatologista enviasse, junto ao material cirúrgico, foto clínica e dermatoscópica da lesão melanocítica, assinalada com os pontos de preocupação do clínico. Como a dermatoscopia é de grande valor para o clínico, 2 isso poderia ser compartilhado com o patologista pelo exame dermatoscópi-co ex vivo da peça cirúrgica.Nós também resolvemos explorar e ampliar a ideia da dermatoscopia ex vivo como método auxiliar à histopatologia com os seguintes objetivos:1. treinar o dermopatologista para familiarização com a linguagem dermatoscópica; 2. avaliar se a dermatoscopia ex vivo com dermatoscópio de contato reduz o enrugamento da peça cirúrgica, como ocorreu no trabalho de Scope et al., 1 que utilizou dermatoscópio de luz polarizada sem contato; 3 3. avaliar se a dermatoscopia in vivo e a dermatoscopia ex vivo podem ser comparadas; 553

Sensitivity and specificity of ex vivo dermatoscopy: a case series

“…In insufficiently fixed biopsy specimens, some vascular red color can still be observed . Loss of red and fine vascular structures was observed in our EVD study as well as by other authors . Optical clearing of the tissue by methylene glycol, the hydrated metabolite of formaldehyde, during the fixation process results in reduced scattering of the light in collagenous skin tissue, and the resulting deeper penetration of the light might explain the accentuation and appearance of blue and white color .…”

“…9 Loss of red and fine vascular structures was observed in our EVD study as well as by other authors. [7][8][9][10] Optical clearing of the tissue by methylene glycol, the hydrated metabolite of formaldehyde, during the fixation process results in reduced scattering of the light in To the best of our knowledge, there has been no published study on EVD sensitivity and specificity, so we could not compare our results regarding pigment content.…”

“…Scope and coworkers were the first to publish an observation that dermatoscopy can be applied to fixed tissues in the pathology laboratory . Dermatoscopy after excision of the tumor ( ex vivo dermatoscopy [EVD]) can be applied on fresh tissue specimens or after formalin fixation . It has been reported that in vivo dermatoscopy (IVD) images and EVD images of the skin tumors were comparable .…”

“…7 Dermatoscopy after excision of the tumor (ex vivo dermatoscopy [EVD]) can be applied on fresh tissue specimens 8 or after formalin fixation. [9][10][11][12] It has been reported that in vivo dermatoscopy (IVD) images and EVD images of the skin tumors were comparable. 9,10 Opposite to IVD, sensitivity, specificity, and diagnostic accuracy of EVD is unknown.…”

Ex Vivo Dermoscopy of Cutaneous Biopsies for Melanocytic Neoplasms

“…It is the most widely used new imaging techniques for the early clinical detection of melanoma and has provided novel insights into nevus origins, evolutionary changes in nevi, classification of pigmented skin lesions, morphologic-molecular correlations, and new variants of nevi and melanoma. 16,17 We implemented EVD with electronic image capture as a routine part of the prosection of pigmented lesions beginning in 2009. 9-11 Some authors have proposed that dermoscopic images be made available to pathologists examining biopsies of pigmented skin lesions.…”