Using optical coherence tomography to optimize Mohs micrographic surgery.

Autor: Akella SS; Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA.; Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Lee J; Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA., May JR; School of Medicine, University of Illinois-Chicago, Chicago, IL, USA., Puyana C; Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA., Kravets S; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA., Dimitropolous V; Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA., Tsoukas M; Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA., Manwar R; Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA., Avanaki K; Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA. avanaki@uic.edu.; Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA. avanaki@uic.edu.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2024 Apr 17; Vol. 14 (1), pp. 8900. Date of Electronic Publication: 2024 Apr 17.
DOI: 10.1038/s41598-024-53457-7
Abstrakt: Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value =  < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages.
(© 2024. The Author(s).)
Databáze: MEDLINE
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