LB921 Role of VivaScope ® 2500 in skin pathology: Advantages, limitations, and future prospects

Abstract

The purpose is to highlight the advantages, limitations and future prospects of a novel cutaneous imaging device (VIvaScope 2500) that was used in a clinical setting for 6 months. This device was used as an adjunct device in a dermatology clinic. This device was used to view margins of excised cutaneous cancers while performing Mohs surgeries; this device was also used to image many excisions that were performed in the clinic before sending them to the histology lab. The staining protocol that we used for freshly excised tissues included 1)Dipping in 20 % Acetic Acid for 30 secs , followed by 2) Dipping in 0.5 mM Acridine Orange solution for 30 secs, followed by 3) Dipping in Normal saline to remove excess dye. Ex Vivo Microscopy (EVM) expedites the process to view skin pathology. It takes approximately 5 minutes to view the excised tissue under VivaScope as compared to frozen sectioning which takes 20 minutes on average. EVM is an ideal device to view margins of cutaneous tumors. This feature allows it to be an excellent adjunct tool to be used clinically to expedite Mohs surgeries. EVM can serve as an adjunct tool to confirm the diagnosis of clinically benign lesions. The use of ex vivo microscopy is not without limitation , compared to traditional formalin-fixed paraffin-embedded (FFPE) tissue sections, the image's resolution is still incomparable. Despite good nuclear contrast, there is still a considerable gap in resolution for ex vivo imaging. In diagnostic pathology, a subtle change in the nucleus can be interpreted as mild dysplasia, which is evident in FFPE slides, not ex vivo microscopic (EVM) images. There is great potential in this new ex vivo imaging tool. It allows real time quasi histologic microscopic examination of freshly excised cutaneous tissue and does not require traditional tissue embedding, processing and sectioning.