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Implications for Microscopically Guided Surgery

Armin Gerger, MD; Michael Horn, MD; Silvia Koller, MD; Wolfgang Weger, MD; Cesare Massone, MD; Bernd Leinweber, MD; Helmut Kerl, MD; Josef Smolle, MD

Arch Dermatol. 2005;141:1269-1274.

Objective  To evaluate the diagnostic accuracy of confocal examination of basal cell carcinoma (BCC) in microscopy-guided surgery.

Design  Four independent observers with no previous experience in confocal laser scanning (CLS) microscopy received standardized instruction about diagnostic CLS microscopic features. Subsequently, 120 confocal images of fresh excisions from BCCs or normal skin were evaluated by each observer, imaged using a commercially available, near-infrared, reflectance CLS microscope. Logistic regression analysis was performed on a combination of all morphologic features using the forward-stepwise (Wald) method. Reliability (interobserver agreement) data were evaluated by statistic.

Setting  Department of Dermatology, Medical University of Graz.

Patients  Twenty patients with histologically verified BCC.

Interventions  Evaluation of fresh BCC excisions by CLS microscopy.

Main Outcome Measures  Diagnostic accuracy of the method was evaluated by ² test. Diagnostic impact and reliability of each morphologic feature were evaluated by logistic regression analysis and statistic, respectively.

Results  Overall, high diagnostic accuracy was achieved by the 4 observers. Logistic regression analysis revealed that mainly tumor cell nuclei and tumor nests should be taken into account for diagnostic decisions, whereas disintegration of tumor cells, peripheral palisading, and retraction of stroma were rarely useful. However, most of the features were highly reliable.

Conclusions  This diagnostic validation study of CLS microscopy in microscopy-guided surgery yielded promising results and opens avenues for further studies. In the future, CLS microscopy may guide microsurgery of any skin cancer.

Author Affiliations: Department of Dermatology (Drs Gerger, Horn, Koller, Weger, Massone, Leinweber, and Kerl), Division of Analytic-Morphologic Dermatology (Dr Smolle), Medical University of Graz, Graz, Austria.

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