Application of <i>in vivo</i>
 reflectance confocal microscopy and <i>ex vivo</i>
 fluorescence confocal microscopy in the most common subtypes of basal cell carcinoma and correlation with histopathology

Villarreal‐Martínez, Alejandra; Bennàssar, Antoni; González, Salvador; Malvehy, Josep; Puig, Susana

doi:10.1111/bjd.16421

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…Currently, several non-invasive techniques, such as dermoscopy, high frequency ultrasound, and reflectance confocal microscopy, are used to identify the BCC subtype and support the treatment decision. However, histopathology remains the gold standard for BCC subtyping [5][6][7][8]. A skin biopsy is usually the technique performed for this purpose.…”

Section: Introductionmentioning

confidence: 99%

Use of Cytology in the Diagnosis of Basal Cell Carcinoma Subtypes

Pasquali

Segurado‐Miravalles²,

Castillo

et al. 2020

JCM

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Background: Basal cell carcinoma (BCC) is the most common skin cancer in the white population. Nonsurgical treatments are first-line alternatives in superficial BCC (sBCC); therefore, differentiating between sBCC and non-sBCC is of major relevance for the clinician. Scraping cytology possesses several advantages, such as an earlier diagnosis and scarring absence, in comparison to a biopsy. Nevertheless, previous studies reported difficulties in differentiating the different BCC subtypes. The objective of this study was to determine the capability and accuracy of scraping cytology to differentiate between sBCC and non-sBCC. Methods: In this retrospective study, cytological samples of histologically confirmed BCC were examined. Select cytological features were correlated to BCC subtypes (sBCC or non-sBCC). Results: A total of 84 BCC samples were included (29 sBCC; 55 non-sBCC). An inverse correlation between the diagnosis of sBCC and the presence of mucin, dehiscence, and grade of atypia in the basal cells was observed. The presence of medium and large basal cell clusters correlated directly to a sBCC diagnosis. The presence of clear cells is strongly associated with sBCC. Therefore, Conclusion: Scraping cytology is reliable in differentiating sBCC from other BCC subtypes.

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Section: Introductionmentioning

confidence: 99%

Use of Cytology in the Diagnosis of Basal Cell Carcinoma Subtypes

Pasquali

Segurado‐Miravalles²,

Castillo

et al. 2020

JCM

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“…To date, most studies using ex vivo CM to diagnose BCC describe features using the fluorescence mode and only a few criteria have been described for ex vivo in RCM. Some authors have described the use of in vivo CM for intraoperative margin control …”

Section: Discussionmentioning

confidence: 99%

“…Some authors have described the use of in vivo CM for intraoperative margin control. 5,10,[17][18][19] Both RCM and FCM have advantages and disadvantages when evaluating BCCs. Reflectance improves the visualization of the stromal and cytoplasmic features while fluorescence also enhances the visualization of the nuclei.…”

Section: Discussionmentioning

confidence: 99%

Basal cell carcinoma characterization using fusionex vivoconfocal microscopy: a promising change in conventional skin histopathology

et al. 2019

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Summary Background Ex vivo confocal microscopy (CM) works under two modes, fluorescence and reflectance, allowing the visualization of different structures. Fluorescence CM (FCM) requires a contrast agent and has been used for the analysis of basal cell carcinomas (BCCs) during Mohs surgery. Conversely, reflectance CM (RCM) is mostly used for in vivo diagnosis of equivocal skin tumours. Recently, a new, faster ex vivo confocal microscope has been developed which simultaneously uses both lasers (fusion mode). Objectives To describe the BCC features identified on reflectance, fluorescence and fusion modes using this novel device. To determine the best mode to identify characteristic BCC features. To develop a new staining protocol to improve the visualization of BCC under the different modes. Methods From September 2016 to June 2017, we prospectively included consecutive BCCs which were excised using Mohs surgery in our department. The lesions were evaluated using ex vivo CM after routine Mohs surgery. The specimens were first stained with acridine orange and then stained using both acetic acid and acridine orange. Results We included 78 BCCs (35 infiltrative, 25 nodular, 12 micronodular, 6 superficial). Most features were better visualized with the fusion mode using the double staining. We also identified new CM ex vivo features, dendritic and plump cells, which have not been reported previously. Conclusions Our results suggest that nuclei characteristics are better visualized in FCM but cytoplasm and surrounding stroma are better visualized in RCM. Thus, the simultaneous evaluation of reflectance and fluorescence seems to be beneficial due to its complementary effect. What's already known about this topic? Ex vivo fluorescent confocal microscopy (FCM) is an imaging technique that allows histopathological analysis of fresh tissue. FCM is faster – at least one‐third of the time – than conventional methods. FCM has a sensitivity of 88% and a specificity of 99% in detecting basal cell carcinomas (BCCs). What does this study add? Reflectance and fluorescence modes can be used simultaneously in a new ex vivo CM device. Each mode complements the other, resulting in an increase in the detection of BCC features in fusion mode. A combined staining using acetic acid and acridine orange enhances the visualization of tumour and stroma without damaging the tissue for further histopathological analysis.

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“…The contrast is provided by differences in the refractive index and size of different cellular organelles as well as the extracellular microstructures within the tissue . RCM is a novel non‐invasive, real‐time, and repeatable diagnostic tool that has recently been applied for the evaluation of various skin diseases, including seborrheic keratosis, actinic keratosis, nevus, basal cell carcinoma, verruca plana, and psoriasis …”

Section: Discussionmentioning

confidence: 99%

“…5 RCM is a novel non-invasive, real-time, and repeatable diagnostic tool that has recently been applied for the evaluation of various skin diseases, including seborrheic keratosis, actinic keratosis, nevus, basal cell carcinoma, verruca plana, and psoriasis. 3,4,[6][7][8][9] At present, the reported RCM criteria of SK include cerebriform surface structures, 10,11 keratin-filled invaginations, corneal pseudocysts, and a regular honeycomb pattern 12 at epidermal layers; cords, 12,13 densely packed round to polymorphous and wellcircumscribed dermal papillae 4,11 at the dermo-epidermal junction;…”

Section: Discussionmentioning

confidence: 99%