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• W2895020240 abstract "To the Editor: Optical coherence tomography (OCT) has been used as a noninvasive imaging technique to guide initial tumor margin delineation before Mohs microscopic surgery.1Cheng H.M. Guitera P. Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma.Br J Dermatol. 2015; 173: 1371-1380Crossref PubMed Scopus (51) Google Scholar In this study, we evaluated the ability of Gabor-domain optical coherence microscopy (GD-OCM) to assist Mohs surgeons in predicting and reducing the number of stages required for tumor clearance. GD-OCM is an advanced version of OCT that achieves invariant lateral and depth resolution of 2 μm throughout the imaged volume.2Murali S. Thompson K.P. Rolland J.P. Three-dimensional adaptive microscopy using embedded liquid lens.Opt Lett. 2009; 34: 145-147Google Scholar Unlike other commercial OCT systems (Table I),1Cheng H.M. Guitera P. Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma.Br J Dermatol. 2015; 173: 1371-1380Crossref PubMed Scopus (51) Google Scholar GD-OCM provides cellular resolution in cross-sectional and en-face images, helping to delineate subclinical basal cell carcinomas. The ability of GD-OCM to guide diagnosis of nonmelanoma skin cancers as a hand-held device has been previously validated with ex vivo samples.3Lee K.S. Zhao H. Ibrahim S.F. Meemon N. Khoudeir L. Rolland J.P. Three-dimensional imaging of normal skin and nonmelanoma skin cancer with cellular resolution using Gabor domain optical coherence microscopy.J Biomed Opt. 2012; 17: 126006Google Scholar, 4Cogliati A. Canavesi C. Hayes A. et al.MEMS-based handheld scanning probe with pre-shaped input signals for distortion-free images in Gabor-domain optical coherence microscopy.Opt Express. 2016; 24: 13365-13374Google ScholarTable IOCT systems comparisonSystemLight source bandwidthImaging depth, mmLateral resolution, μmAxial/vertical resolution, μmField of view, mmAscan rate, kHZContactHandheldFDA clearedVivoSight OCT (Michelson Diagnostics, Orpington, UK)1305 nm<27.556 × 620NoYesYesCallisto (Thorlabs, Newton, NJ)930 nm1.385.310 × 101.2NoNoNoGD-OCM 4D.R0/R15 (LighTopTechWest Henrietta, NY)840 nm1.62.852.61.5 × 1.581EitherYesNoLight-CT Scanner (LLTech, Princeton, NJ)700 nm11.511.3 × 1.3FF-OCT NA/en-faceSilicone oilNoNoAdapted from Cheng et al.1Cheng H.M. Guitera P. Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma.Br J Dermatol. 2015; 173: 1371-1380Crossref PubMed Scopus (51) Google ScholarFDA, Food and Drug Administration; FF-OCT, full-field optical coherence tomography; GD-OCM, Gabor-domain optical coherence microscopy; NA, not applicable; OCT, optical coherence tomography. Open table in a new tab Adapted from Cheng et al.1Cheng H.M. Guitera P. Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma.Br J Dermatol. 2015; 173: 1371-1380Crossref PubMed Scopus (51) Google Scholar FDA, Food and Drug Administration; FF-OCT, full-field optical coherence tomography; GD-OCM, Gabor-domain optical coherence microscopy; NA, not applicable; OCT, optical coherence tomography. Twenty-eight patients undergoing Mohs microscopic surgery for biopsy-proven basal cell carcinoma were enrolled. For each tumor, the surgeon drew a clinical margin to outline the first stage (Fig 1, A). An imaging scientist then placed steri-strips on the drawn margin orientations (at 3, 12, 9, and 6 o'clock) to serve as references for image collection. As anatomic location allowed, 6 images were collected along the 4 margin orientations (Fig 1, B and C). After image collection, the surgeon completed a standard Mohs procedure without any prior knowledge of the imaging outcome. If the surgeon began to curette and felt tumor extending beyond what was initially visible and drawn, he included up to an additional 2 mm of tissue beyond the drawn margin. When surgery was complete, the distance between the final margin and the steri-strip reference marks was measured for comparison with GD-OCM margin images. Due to motion during image collection, 8 of 28 patients had uninterpretable GD-OCM images. In total, 20 patients with 38 margin orientations (6 × 38 = 228 GD-OCM images) were examined by 2 authors (Drs Tankam and Soh) and compared with frozen-section histology (Table II; Fig 2). In 25 of 38 (65.8%) cases, GD-OCM image review revealed tumor within the final surgical margin. In the remaining 13 (34.2%) cases, the GD-OCM images were interpreted as tumor outside of the final histology margin. In 11 of 11 cases requiring multiple stages, the GD-OCM images revealed tumor beyond 2 mm of the drawn clinical margin; from this, we inferred that an additional Mohs stage would be required. The GD-OCM–determined margin and the final surgical margin were within ±1 mm of agreement in 23 of 38 (60.5%) cases.Table IIPatient and tumor characteristicsCategoryValue%Patients enrolled, n28Patients with incomplete data, n8Total biopsies diagnosed as BCC, n20 Male1365 Female735Average patient age, y69.1Tumor location, n Forehead840 Cheeks735 Temple210 Lower extremities315Tumor subtypes, n Nodular1575 Infiltrative210 Not specified315Total margins examined, n38BCC, Basal cell carcinoma. Open table in a new tab BCC, Basal cell carcinoma. In this study, GD-OCM was shown to be able to guide margin delineation while planning initial stages for Mohs surgery. In 100% of cases that required multiple stages; GD-OCM data suggested that a single initial stage (ie, clinical margin +2 mm) would be insufficient. This study is limited by the interpretation and acquisition of the images; in ∼34% of cases GD-OCM images revealed tumor outside of the final histologic margin. In these cases, benign structures were misinterpreted as malignant. With standardized training, user interpretation skills can be honed. Another challenge was the motion artifact leading to unreadable images. Last, our inability to collect images on all 4 margin orientations due to the complexity of the anatomic location of the tumor can be addressed with a noncontact probe, which will come at the expense of increased motion artifacts. Download .gif (9.5 MB) Help with gif files Video 1 Download .gif (8.39 MB) Help with gif files Video 2" @default.
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• W2895020240 date "2019-06-01" @default.
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• W2895020240 title "Gabor-domain optical coherence tomography to aid in Mohs resection of basal cell carcinoma" @default.
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• W2895020240 doi "https://doi.org/10.1016/j.jaad.2018.09.029" @default.
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