New Imaging Technique Speeds Removal of Non-Melanoma
Provides same accuracy as current “gold standard”
used in Mohs surgery minus the lengthy wait
Jan. 30, 2014 – Senior citizens, the most frequent
victims of skin cancer, may find a common surgery for non-melanoma skin
cancer, known as Mohs surgery, taking a lot less time. It typically
achieves excellent results but can be a long process, as the surgeon
successively removes the area of concern until the surrounding tissue is
free of cancer. Now, NIBIB-funded researchers have developed a
microscopic technique to analyze removed tissue rapidly right in the
clinic - dramatically reducing the length, inefficiency, and expense of
To determine whether further tissue removal is
necessary in current procedures, the borders of the lesion must be
processed in a laboratory to check for residual cancer tissue - a
process that takes 20 to 45 minutes and is often repeated numerous
With approximately 3.5 million new cases per year
in the U.S., Mohs surgery is a fairly common procedure that many people
undergo repeatedly as new skin cancers appear. It can take one to three
hours, or even longer depending on the size and location of the lesion.
The process is lengthy because after a section of
tissue is removed, it must be frozen and stained so it can be examined
to ensure the borders are clear of residual tumor. Although highly
effective, the current practice is labor intensive for surgeons and
assisting staff, as well as lengthy and stressful for patients.
The time spent by surgical personnel and those
analyzing the tissue in the lab increases the expense of the procedure,
which has been estimated to cost $ 2-3 billion per year in the U.S.
NIBIB-supported researchers led by Milind
Rajadhyaksha, Ph.D. at Memorial Sloan Kettering are using their
expertise in optical imaging to improve this common procedure. Optical
imaging is a technique that uses visible or near-infrared light to
obtain detailed images of organs, tissues, and cells.
The investigators developed a new pathological
assessment technique called strip mosaicing confocal microscopy -- a
type of optical imaging -- that can provide high resolution images
during removal of basal cell and squamous cell carcinomas (non-melanoma
skin cancers) and perhaps other tumors of the skin.
The new technique uses a focused laser line that
performs multiple scans of the tissue to obtain image “strips” that are
then combined, like a mosaic, into a complete image of the excised
tissue. The process takes only 90 seconds and eliminates the need to
freeze and stain the tissue samples for analysis -- a process that takes
20 to 45 minutes.
The new imaging technique was tested on 17 patients
with 34 tissue samples. The overall image quality was excellent, with
high resolution and contrast, providing for good visibility of the
epidermis and dermis.
Researchers compared the new technique against the
Mohs approach with its frozen section processing. The new technique
achieved a promising 94% in preliminary measures of sensitivity and
specificity for detecting skin cancer margins, which is comparable to
the “gold standard” Mohs procedure.
These preliminary results demonstrated that the
optical technique could potentially detect skin cancer margins with the
same accuracy as the conventional frozen section technique.
The results of this study were obtained under
laboratory conditions; a clinical trial is now being conducted to
demonstrate the feasibility of using this technique in the clinical
setting, the ultimate goal of the research group.
Steve Krosnick, M.D., NIBIB director for the
Program for Image-Guided Interventions, explains the utility of the
optical system: “The technology is particularly well-suited for Mohs-trained
surgeons, who are experts at performing excisions and interpreting
images of tissue samples removed during the Mohs procedure. Image
quality, ability to make accurate interpretations, and time savings will
be key parameters for adoption of the system in the clinical setting,
and the current results are very encouraging.”
The research was conducted by a team consisting of
two laboratories at Memorial Sloan-Kettering Cancer Center, New York,
NY, as well as students from Bronx High School of Science, New York and
Livingston High School, Livingston New Jersey. The work is published in
the October 2013 issue of the British Journal of Dermatology.
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