Background/Objectives: To ensure that non-melanoma skin cancer (NMSC) is completely removed in healthy tissue, micrographically controlled surgery (3D histology) is often performed, which can prolong the inpatient stay. This study examined ex vivo reflectance confocal microscopy (evRCM) for perioperative assessment of surgical margins, specifically in cases where re-excision was necessary due to incomplete removal of cutaneous tumor tissue. Methods: NMSC re-excisions were evaluated using evRCM by a cutaneous surgeon, with retrospective review by an independent pathologist when results differed from histology. Results: evRCM demonstrated high specificity (0.96; 95% CI, 0.90–0.99) but low sensitivity (0.20; 95% CI, 0.06–0.51). Unlike pathology, which discards outer surgical margins, evRCM examined the true surgical margins. Retrospective pathology analysis of the misdiagnosed cases confirmed that 25% (n= 2/8) were false negative and 75% (n= 6/8) were potentially false positive, resulting in a sensitivity of 0.2–0.8. Notably, evRCM led to a 113-day reduction in in-hospital stays, probably resulting in increased patient satisfaction and cost-effectiveness. Conclusions: evRCM was valuable for speeding up the assessment of surgical margins in patients with re-excised NMSC. Proper tissue preparation and assessment require interdisciplinary collaboration between cutaneous surgeons, pathologists, and physician assistants, emphasizing the need for standardized operating procedures.
背景/目的：为确保非黑色素瘤皮肤癌（NMSC）在健康组织中被完全切除，常采用显微图像控制手术（三维组织学检查），这可能延长患者住院时间。本研究探讨了离体反射式共聚焦显微镜（evRCM）在围手术期评估手术切缘的应用价值，特别是在因皮肤肿瘤组织切除不完整而需再次切除的病例中。方法：由皮肤外科医师使用evRCM对NMSC再切除标本进行评估，当结果与组织学检查不一致时，由独立病理医师进行回顾性复核。结果：evRCM显示出高特异性（0.96；95% CI，0.90–0.99）但低敏感性（0.20；95% CI，0.06–0.51）。与病理学检查丢弃外侧手术切缘不同，evRCM可检测真实手术切缘。对误诊病例的回顾性病理分析证实，25%（n=2/8）为假阴性，75%（n=6/8）可能为假阳性，导致敏感性范围为0.2–0.8。值得注意的是，evRCM使住院时间缩短113天，可能提高患者满意度并增强成本效益。结论：evRCM对于加速NMSC再切除患者手术切缘评估具有重要价值。规范的组织制备与评估需要皮肤外科医师、病理医师及医师助理的多学科协作，并需建立标准化操作流程。
肿瘤(癌症)患者之家