Tri-modal confocal mosaics detect residual invasive squamous cell carcinoma in Mohs surgical excisions

Dan Gareau, Anna Bar, Nicholas Snaveley, Ken Lee, Nathaniel Chen, Neil Swanson, Eric Simpson, Steve Jacques

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

For rapid, intra-operative pathological margin assessment to guide staged cancer excisions, multimodal confocal mosaic scan image wide surgical margins (approximately 1 cm) with sub-cellular resolution and mimic the appearance of conventional hematoxylin and eosin histopathology (H&E). The goal of this work is to combine three confocal imaging modes: acridine orange fluorescence (AO) for labeling nuclei, eosin fluorescence (Eo) for labeling cytoplasm, and endogenous reflectance (R) for marking collagen and keratin. Absorption contrast is achieved by alternating the excitation wavelength: 488 nm (AO fluorescence) and 532 nm (Eo fluorescence). Superposition and false-coloring of these modes mimics H&E, enabling detection of cutaneous squamous cell carcinomas (SCC). The sum of mosaic Eo R is false-colored pink to mimic the appearance of eosin, while the AO mosaic is false-colored purple to mimic the appearance of hematoxylin in H&E. In this study, mosaics of 10 Mohs surgical excisions containing invasive SCC, and five containing only normal tissue were subdivided for digital presentation equivalent to 4 histology. Of the total 50 SCC and 25 normal sub-mosaics presented, two reviewers made two and three type- 2 errors (false positives), respectively. Limitations to precisely mimic H&E included occasional elastin staining by AO. These results suggest that confocal mosaics may effectively guide staged SCC excisions in skin and other tissues.

Original languageEnglish (US)
Article number066018
JournalJournal of biomedical optics
Volume17
Issue number6
DOIs
StatePublished - Jun 1 2012

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Keywords

  • Cancer screening
  • Confocal
  • Fluorescence
  • Imaging
  • Mohs surgery
  • Squamous cell carcinoma

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Biomedical Engineering

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