Intra-operative confocal imaging-guided Mohs surgery

术中共聚焦成像引导莫氏手术

• 批准号: 6917842
• 负责人: MILIND RAJADHYAKSHA
• 金额: $ 5.41万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-20 至 2005-11-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6917842
• 关键词: adolescence (12-20); adult human (21+); aluminum; basal cell carcinoma; bioengineering /biomedical engineering; bioimaging /biomedical imaging; biomedical equipment development; chloride ion; clinical research; human subject; image guided surgery /therapy; imaging /visualization /scanning; microscopy

DESCRIPTION (provided by applicant): The goal of this proposal is to develop and clinically test a real-time optical imaging modality based on confocal reflectance microscopy, with enhancement of nuclear-to-dermal contrast using acetic acid and crossed polarization, to intra-operatively examine basal cell cancers to guide Mohs micrographic surgery. Basal cell cancers (BCCs) are among the fastest growing cancers (>1.2 million new USA cases/year); because they occur most frequently on older people and in high risk anatomical sites (near or on the eyes, mouth, nose, ears), precise microsurgery is necessary with minimum damage to the surrounding normal tissue. Mohs surgery is time-consuming (one to several hours) and tedious because several (2-20) excisions must be made, and frozen histology sections carefully prepared and examined for each. Realtime confocal reflectance imaging may make Mohs surgery significantly more efficient by enabling direct intraoperative examination for cancer nests and cancer-to-normal tissue margins on the patient; this will reduce the number of excisions and avoid frozen histology. Both the patient and surgeon will save several hours per procedure in the operating room. Although proposed for Mohs surgery of BCCs, this real-time intra-operative imaging modality may, in fact, prove useful in a variety of other microsurgical settings. The research will be a collaboration between Northeastern University (Boston) and Memorial Sloan-Kettering Cancer Center (New York). This project will be implemented in two phases: (1) an ex vivo study using freshly excised skin specimens from Mohs surgeries, to (a) design a confocal microscope that mimics the Mohs surgeon's examination of frozen histology: rapid low-resolution examination of BCC nests in wide fields-of-view followed by high-resolution inspection of nuclear morphology in small fields-of-view, and develop (b) optimum contrast enhancement methods using topical acetic acid (induces condensation of chromatin that increases light backscatter from nuclei) and optical crossed polarization (suppresses light backscatter from the surrounding normal dermis), (c) optimum hemostasis methods using either topical aluminum chloride or electrocautery, (d) image understanding by detailed correlation of images to histology; and (2) an intraoperative study, involving (a) design of a specialized confocal articulated telescope, to enable (b) imaging of BCCs on patients during surgery, to evaluate the optimum contrast enhancement and hemostasis methods, correlate confocal images to histology and quantitatively determine diagnostic/screening accuracy. The overall goal is to develop an optical (confocal) intra-operative imaging instrument for Mohs and other modes of microsurgery.

描述（由申请人提供）： 该提案的目的是基于共焦反射显微镜开发和临床测试实时光学成像模态，并使用乙酸和交叉极化来增强核对面对比度，以检查术中的基础细胞癌，以指导MOHS显微照片手术。基底细胞癌（BCC）是增长最快的癌症之一（> 120万新的美国病例）；由于它们最常发生在老年人和高风险的解剖部位（靠近眼睛，嘴巴，鼻子，耳朵），因此需要精确的显微外科手术，对周围正常组织的损害最小。 MOHS手术是耗时的（一到几个小时），并且乏味，因为必须进行几项（2-20）的切口，并且对每个杂志进行了冻结的组织学切片，并为每种切割进行了精心准备和检查。实时共聚焦反射成像可以通过对患者的癌症巢和癌症至分布的组织边缘进行直接术中检查，从而使MOHS手术更加有效。这将减少切除次数并避免组织学冷冻。患者和外科医生都可以在手术室节省几个小时。尽管提出了用于BCC的MOHS手术，但这种实时的术中成像方式实际上可能在其他各种显微外科环境中被证明是有用的。这项研究将是东北大学（波士顿）和纪念斯隆 - 凯特林癌症中心（纽约）之间的合作。该项目将分为两个阶段：（1）一项在体内研究，使用新鲜切除的皮肤标本从MOHS手术中进行，到（a）设计一个共焦显微镜，模拟了MOHS外科医生对冻结的组织学检查的检查：对BCC的快速低分辨率检查，对BCC的快速分辨率进行了良好的视野，并在核近分范围内进行了良好的核文化概念（BCC），并进行了核工程学（BCC），并进行了核差异学（BCC），并进行了核差异学研究，并构成了核差异。使用局部乙酸的增强方法（诱导染色质的凝结，从核中增加光散射的光）和光学交叉极化（抑制周围正常真皮周围的光反向散射），（c）最佳止血方法，使用局部铝氯化物或电动铝含量或电力学（D）通过详细的图像造型的图像造型的止血方法; （2）一项术中研究，涉及（a）设计专用共焦型伸缩望远镜，以使（b）手术期间对患者进行BCC的成像，以评估最佳的对比度增强和止血方法，将共焦图像相关联与组织学相关，并确定诊断/筛查精度。总体目标是开发用于MOHS和其他显微外科模式的光学（共聚焦）术中成像仪器。