Ex vivo confocal microscopy for surgical margin assessment: A histology‐compared study on 109 specimens

Abstract Purpose Currently, approximately 11–38% of prostate cancer (PCa) patients undergoing radical prostatectomy have a positive surgical margin (PSM) on histopathology. Cerenkov luminescence imaging (CLI) using 68Ga-prostate-specific membrane antigen (68Ga-PSMA) is a novel technique for intraoperative margin assessment. The aim of this first-in-man study was to investigate the feasibility of intraoperative 68Ga-PSMA CLI. In this study, feasibility was defined as the ability to distinguish between a positive and negative surgical margin, imaging within 45 min and low radiation exposure to staff. Methods Six patients were included in this ongoing study. Following perioperative i.v. injection of ~ 100 MBq 68Ga-PSMA, the prostate was excised and immediately imaged ex vivo. Different acquisition protocols were tested, and hotspots on CLI images from the intact prostate were marked for comparison with histopathology. Results By using an acquisition protocol with 150 s exposure time, 8 × 8 binning and a 550 nm shortpass filter, PSMs and negative surgical margins (NSMs) were visually correctly identified on CLI in 3 of the 5 patients. Two patients had a hotspot on CLI from cancer < 0.1 mm from the excision margin. Conclusion Overall, the study showed that 68Ga-PSMA CLI is a feasible and low-risk technique for intraoperative margin assessment in PCa. The remaining patients in this ongoing study will be used to assess the diagnostic accuracy of the technique. Trial registration: NL8256 registered at www.trialregister.nl on 04/11/20109.

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Assessing Breast Cancer Margins Ex Vivo Using Aqueous Quantum-Dot-Molecular Probes

International Journal of Surgical Oncology ◽

10.1155/2012/861257 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12

Author(s):

Giang H. T. Au ◽

Wan Y. Shih ◽

Wei-Heng Shih ◽

Linette Mejias ◽

Vanlila K. Swami ◽

...

Keyword(s):

Breast Cancer ◽

Assessment Tool ◽

Ex Vivo ◽

Surgical Margin ◽

Assessment Method ◽

Molecular Probes ◽

Molecular Probe ◽

Margin Assessment ◽

Surgical Specimen ◽

Positive Margins

Positive margins have been a critical issue that hinders the success of breast- conserving surgery. The incidence of positive margins is estimated to range from 20% to as high as 60%. Currently, there is no effective intraoperative method for margin assessment. It would be desirable if there is a rapid and reliable breast cancer margin assessment tool in the operating room so that further surgery can be continued if necessary to reduce re-excision rate. In this study, we seek to develop a sensitive and specific molecular probe to help surgeons assess if the surgical margin is clean. The molecular probe consists of the unique aqueous quantum dots developed in our laboratory conjugated with antibodies specific to breast cancer markers such as Tn-antigen. Excised tumors from tumor-bearing nude mice were used to demonstrate the method. AQD-Tn mAb probe proved to be sensitive and specific to identify cancer area quantitatively without being affected by the heterogeneity of the tissue. The integrity of the surgical specimen was not affected by the AQD treatment. Furthermore, AQD-Tn mAb method could determine margin status within 30 minutes of tumor excision, indicating its potential as an accurate intraoperative margin assessment method.

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Features of oral squamous cell carcinoma in ex vivo fluorescence confocal microscopy

International Journal of Dermatology ◽

10.1111/ijd.15152 ◽

2020 ◽

Author(s):

Veronika Shavlokhova ◽

Christa Flechtenmacher ◽

Sameena Sandhu ◽

Michael Vollmer ◽

Jürgen Hoffmann ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Confocal Microscopy ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Ex Vivo ◽

Fluorescence Confocal Microscopy

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Surgical Margin Assessment

Surgical Pathology ◽

10.1007/978-3-030-53690-9_21 ◽

2020 ◽

pp. 127-130

Author(s):

Ahmad Altaleb

Keyword(s):

Surgical Margin ◽

Margin Assessment

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In Vivo Confocal Microscopy Evaluation in Patients with Keratoconus

Journal of Clinical Medicine ◽

10.3390/jcm11020393 ◽

2022 ◽

Vol 11 (2) ◽

pp. 393

Author(s):

Alvin Wei Jun Teo ◽

Hassan Mansoor ◽

Nigel Sim ◽

Molly Tzu-Yu Lin ◽

Yu-Chi Liu

Keyword(s):

Confocal Microscopy ◽

Nerve Regeneration ◽

Nerve Fibre ◽

Ex Vivo ◽

Fibre Length ◽

In Vivo Confocal Microscopy ◽

Corneal Sensitivity ◽

Mechanical Removal ◽

Cellular Changes

Keratoconus is the most common primary corneal ectasia characterized by progressive focal thinning. Patients experience increased irregular astigmatism, decreased visual acuity and corneal sensitivity. Corneal collagen crosslinking (CXL), a minimally invasive procedure, is effective in halting disease progression. Historically, keratoconus research was confined to ex vivo settings. In vivo confocal microscopy (IVCM) has been used to examine the corneal microstructure clinically. In this review, we discuss keratoconus cellular changes evaluated by IVCM before and after CXL. Cellular changes before CXL include decreased keratocyte and nerve densities, disorganized subbasal nerves with thickening, increased nerve tortuosity and shortened nerve fibre length. Repopulation of keratocytes occurs up to 1 year post procedure. IVCM also correlates corneal nerve status to functional corneal sensitivity. Immediately after CXL, there is reduced nerve density and keratocyte absence due to mechanical removal of the epithelium and CXL effect. Nerve regeneration begins after 1 month, with nerve fibre densities recovering to pre-operative levels between 6 months to 1 year and remains stable up to 5 years. Nerves remain tortuous and nerve densities are reduced. Corneal sensitivity is reduced immediately postoperatively but recovers with nerve regeneration. Our article provides comprehensive review on the use of IVCM imaging in keratoconus patients.

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