Aktuelle Dermatologie 2020; 46(04): 152-157
DOI: 10.1055/a-1072-7162
Übersicht

Ex vivo konfokale Laserscanmikroskopie – die neue Bedside-Histologie

Ex vivo Confocal Laserscanmicroscopy – New Bedside-Histology
D. Hartmann
Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München
› Author Affiliations

Zusammenfassung

Ex vivo konfokale Laserscanmikroskopie (ex vivo KLM) bietet eine schnelle histopathologische Untersuchung des frisch exzidierten Gewebes mit der Möglichkeit, eine schnittrandkontrollierte Chirurgie (Mohs-Chirurgie) direkt intraoperativ durchzuführen. Die aktuelle Literatur zeigt vielversprechende Ergebnisse insbesondere bei der Beurteilung von Basalzellkarzinomen. Überdies hinaus gibt es zahlreiche Hinweise, dass man diese innovative diagnostische Maßnahme auch bei der Untersuchung anderer nicht melanozytärer und melanozytärer Hautneoplasien sowie für entzündliche und infektiöse Dermatosen einsetzen kann. Dieser Beitrag fasst bisherige Erkenntnisse und Erfahrungen zur ex vivo KLM zusammen und bietet eine Übersicht der aktuellen Literatur zu diesem Thema.

Abstract

Ex vivo confocal laser scanning microscopy (ex vivo CLSM) provides a fast, histopathological examination of freshly excised tissue with the ability to perform a microscopically controlled surgery (Mohs surgery) directly intraoperatively. The current literature shows promising results especially in the assessment of basal cell carcinoma. In addition, there are numerous indications that this innovative diagnostic measure can also be used in the study of other non-melanocytic and melanocytic skin neoplasms as well as for inflammatory and infectious dermatoses. This article summarizes previous findings and experiences on ex vivo CLSM and provides an overview of current literature on this topic.



Publication History

Article published online:
05 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Hartmann D, Ruini C, Mathemeier L. et al. Identification of ex-vivo confocal scanning microscopic features and their histological correlates in human skin. J Biophotonics 2016; 9: 376-387
  • 2 Hartmann D, Ruini C, Mathemeier L. et al. Identification of ex-vivo confocal laser scanning microscopic features of melanocytic lesions and their histological correlates. J Biophotonics 2017; 10: 128-142
  • 3 Welzel J, Kastle R, Sattler EC. Fluorescence (Multiwave) Confocal Microscopy. Dermatol Clin 2016; 34: 527-533
  • 4 Hartmann D, Krammer S, Vural S. et al. Immunofluorescence and confocal microscopy for ex-vivo diagnosis of melanocytic and non-melanocytic skin tumors: A pilot study. J Biophotonics 2018; 11: 3
  • 5 Hartmann D, Krammer S, Bachmann MR. et al. Simple 3-criteria-based ex vivo confocal diagnosis of basal cell carcinoma. J Biophotonics 2018; 11: e201800062
  • 6 Hartmann D, Krammer S, Bachmann MR. et al. Ex vivo confocal microscopy features of cutaneous squamous cell carcinoma. J Biophotonics 2018; 11: e201700318
  • 7 Hartmann D, Krammer S, Ruini C. et al. Correlation of histological and ex-vivo confocal tumor thickness in malignant melanoma. Lasers Med Sci 2016; 31: 921-927
  • 8 Karen JK, Gareau DS, Dusza SW. et al. Detection of basal cell carcinomas in Mohs excisions with fluorescence confocal mosaicing microscopy. Br J Dermatol 2009; 160: 1242-1250
  • 9 Cinotti E, Perrot JL, Labeille B. et al. First identification of the herpes simplex virus by skin-dedicated ex vivo fluorescence confocal microscopy during herpetic skin infections. Clin Exp Dermatol 2015; 40: 421-425
  • 10 Bertoni L, Azzoni P, Reggiani C. et al. Ex vivo fluorescence confocal microscopy for intraoperative, real-time diagnosis of cutaneous inflammatory diseases: A preliminary study. Exp Dermatol 2018; 27: 1152-1159
  • 11 Cinotti E, Perrot JL, Labeille B. et al. Hair dermatophytosis diagnosed by reflectance confocal microscopy: six cases. J Eur Acad Dermatol Venereol 2015; 29: 2257-2259
  • 12 Schiffhauer LM, Boger JN, Bonfiglio TA. et al. Confocal microscopy of unfixed breast needle core biopsies: a comparison to fixed and stained sections. BMC Cancer 2009; 9: 265
  • 13 Forest F, Cinotti E, Yvorel V. et al. Ex vivo confocal microscopy imaging to identify tumor tissue on freshly removed brain sample. Neurooncol 2015; 124: 157
  • 14 Ragazzi M, Piana S, Longo C. et al. Fluorescence confocal microscopy for pathologists. Mod Pathol 2014; 27: 460
  • 15 Debarbieux S, Gaspar R, Depaepe L. et al. Intraoperative diagnosis of nonpigmented nail tumours with ex vivo fluorescence confocal microscopy: 10 cases. Br J Dermatol 2015; 172: 1037
  • 16 Fattouh K, Debarbieux S, Depaepe L. et al. Routine use of perioperative in vivo reflectance confocal microscopy of the nail matrix in melanonychia striata: about 30 cases. Br J Dermatol 2017; 177: 570
  • 17 Bağcı IS, Aoki R, Krammer S. et al. Ex vivo confocal laser scanning microscopy: an innovative method for direct immunofluorescence of cutaneous vasculitis. J Biophotonics 2019; 12: e201800425
  • 18 Bağcı IS, Aoki R, Krammer S. et al. Ex vivo confocal laser scanning microscopy for bullous pemphigoid diagnostics: new era in direct immunofluorescence?. J Eur Acad Dermatol Venereol 2019; 33: 2123-2130
  • 19 Bini J, Spain J, Nehal K. et al. Confocal mosaicing microscopy of human skin ex vivo: spectral analysis for digital staining to simulate histology-like appearance. J Biomed Opt 2011; 16: 076008
  • 20 Longo C, Pampena R, Bombonato C. et al. Diagnostic accuracy of ex vivo fluorescence confocal microscopy in Mohs surgery of basal cell carcinomas: a prospective study on 753 margins. Br J Dermatol 2019; 180: 1473-1480
  • 21 Cinotti E, Perrot JL, Labeille B. et al. Ex vivo confocal microscopy: an emerging technique in dermatology. Dermatol Pract Concept 2018; 8: 109-119
  • 22 Gareau DS. Feasibility of digitally stained multimodal confocal mosaics to simulate histopathology. J Biomed Opt 2009; 14: 034050
  • 23 El Hallani S, Poh CF, Macaulay CE. et al. Ex vivo confocal imaging with contrast agents for the detection of oral potentially malignant lesions. Oral Oncol 2013; 49: 582-590
  • 24 Longo C, Ragazzi M, Gardini S. et al. Ex vivo fluorescence confocal microscopy in conjunction with Mohs micrographic surgery for cutaneous squamous cell carcinoma. J Am Acad Dermatol 2015; 73: 321-232
  • 25 Chung VQ, Dwyer PJ, Nehal KS. et al. Use of ex vivo confocal scanning laser microscopy during Mohs surgery for nonmelanoma skin cancers. Dermatol Surg 2004; 30: 1470-1478
  • 26 Horn M, Gerger A, Koller S. et al. The use of confocal laser-scanning microscopy in microsurgery for invasive squamous cell carcinoma. Br J Dermatol 2007; 156: 81-88
  • 27 Caspers PJ, Lucassen GW, Puppels GJ. Combined in vivo confocal Raman spectroscopy and confocal microscopy of human skin. Biophys J 2003; 85: 572-580
  • 28 Bisschops R, Bergman J. Probe-based confocal laser endomicroscopy: scientific toy or clinical tool?. Endoscopy 2010; 42: 487-489
  • 29 Bennàssar A, Vilalta A, Carrera C. et al. Rapid diagnosis of two facial papules using ex vivo fluorescence confocal microscopy: toward a rapid bedside pathology. Dermatol Surg 2012; 38: 1548-1551
  • 30 Larson B, Abeytunge S, Seltzer E. et al. Detection of skin cancer margins in Mohs excisions with high-speed strip mosaicing confocal microscopy: a feasibility study. Br J Dermatol 2013; 169: 922-926
  • 31 White WM, Baldassano M, Rajadhyaksha M. et al. Confocal reflectance imaging of head and neck surgical specimens. A comparison with histologic analysis. Arch Otolaryngol Head Neck Surg 2004; 130: 923-928
  • 32 Bonnal JL, Rock Jr A, Gagnat A. et al. Confocal laser endomicroscopy of bladder tumors associated with photodynamic diagnosis: an ex vivo pilot study. Urology 2012; 80: 1162.e1-5