Abstract
Confocal mosaicing microscopy is a developing technology platform for imaging tumor margins directly in freshly excised tissue, without the processing required for conventional pathology. Previously, mosaicing on 12-×-12 mm² of excised skin tissue from Mohs surgery and detection of basal cell carcinoma margins was demonstrated in 9 min. Last year, we reported the feasibility of a faster approach called "strip mosaicing," which was demonstrated on a 10-×-10 mm² of tissue in 3 min. Here we describe further advances in instrumentation, software, and speed. A mechanism was also developed to flatten tissue in order to enable consistent and repeatable acquisition of images over large areas. We demonstrate mosaicing on 10-×-10 mm² of skin tissue with 1-μm lateral resolution in 90 s. A 2.5-×-3.5 cm² piece of breast tissue was scanned with 0.8-μm lateral resolution in 13 min. Rapid mosaicing of confocal images on large areas of fresh tissue potentially offers a means to perform pathology at the bedside. Imaging of tumor margins with strip mosaicing confocal microscopy may serve as an adjunct to conventional (frozen or fixed) pathology for guiding surgery.
Highlights
The accurate and complete removal of tumor, with minimal removal of healthy surrounding tissue, is guided by the examination of pathology
In the setting of nonmelanoma skin cancers, frozen pathology that is prepared during Mohs surgery requires 20 to 45 min per excision, and two or more excisions are performed, such that the total preparation time lasts from two to several hours.[1]
The rates of resections can be reduced by aggressive removal of tissue from a wide margin around the tumor, it can affect the functionality of the organ or produce unacceptable aesthetical results for the patient
Summary
The accurate and complete removal of tumor, with minimal removal of healthy surrounding tissue, is guided by the examination of pathology. Preparation of fixed sections requires one to two days. Since it takes such a long time to obtain pathology results, the patient is sent home immediately after surgery. If the pathology shows positive tumor margins, the patient must undergo additional surgery (resection), and/or radiotherapy or chemotherapy. The objective is to minimize the removal of healthy tissue by reducing the margins and still perform complete removal of the tumor. To address this problem, high-resolution optical imaging methods capable of displaying nuclear and cellular
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