Background:Accurate margin assessment during surgical treatment is essential to prevent recurrences of BCC. Mohs surgery or alternative peripheral and deep en-face margin assessment (PDEMA) based on conventional histopathology are considered the gold standard for excising high-risk BCC, as it allows stepwise and complete examination of peripheral and deep margins. However, it is labor-intensive and time-consuming. EVCM has emerged as a promising alternative, allowing rapid intraoperative evaluation of fresh excised tissue.Objective:To assess the diagnostic accuracy of EVCM in a PDEMA workflow of high-risk nodular BCCs.Methods:A retrospective monocentric study was conducted at the Lausanne University Hospital (CHUV) between March 2024 and May 2025. A total of 51 patients with histologically confirmed nodular BCCs considered as high-risk and thus addressed for EVCM-assisted excision were included, yielding 171 surgical margin samples. EVCM and conventional histology-based PDEMA analyses were compared.Results:EVCM achieved an overall sensitivity of 93.8% (95% CI: 71.7–98.9%) and specificity of 98.7% (95% CI: 95.2–99.7%) compared to conventional histology. The positive and negative predictive values were 88.2% (95% CI: 63.6–97.4%) and 99.4% (95% CI: 96.4–99.9%), respectively.Conclusion:EVCM demonstrates high diagnostic accuracy for the intraoperative PDEMA of high-risk, nodular BCC. Its integration in PDEMA surgical workflows may improve efficiency, although confirmatory studies are needed in broader clinical settings.
背景：在手术治疗过程中进行精确的切缘评估对于预防基底细胞癌（BCC）复发至关重要。莫氏手术或基于传统组织病理学的替代性外周及深部切缘评估（PDEMA）被认为是切除高风险BCC的金标准，因其能对周边及深部切缘进行逐步且完整的检查。然而，该方法操作繁琐且耗时。外反射共聚焦显微镜（EVCM）作为一种有前景的替代技术应运而生，能够对新鲜切除组织进行快速的术中评估。 目的：评估EVCM在高风险结节型BCC的PDEMA工作流程中的诊断准确性。 方法：于2024年3月至2025年5月在洛桑大学医院（CHUV）开展了一项回顾性单中心研究。共纳入51例经组织学确诊为高风险结节型BCC并接受EVCM辅助切除的患者，共获得171个手术切缘样本。研究比较了EVCM与传统组织学PDEMA的分析结果。 结果：与传统组织学相比，EVCM的总体敏感性为93.8%（95% CI：71.7–98.9%），特异性为98.7%（95% CI：95.2–99.7%）。其阳性预测值和阴性预测值分别为88.2%（95% CI：63.6–97.4%）和99.4%（95% CI：96.4–99.9%）。 结论：EVCM在高风险结节型BCC的术中PDEMA评估中展现出较高的诊断准确性。将其整合至PDEMA手术流程可提升工作效率，但尚需在更广泛的临床环境中开展验证性研究。
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