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Rapid visualization of nonmelanoma skin cancer - 18/04/17

Doi : 10.1016/j.jaad.2016.09.008 
Ethan Walker, MD, PhD a, Margaret Mann, MD h, Kord Honda, MD h, Allison Vidimos, MD i, Mark D. Schluchter, PhD b, Brian Straight, PhD e, Matthew Bogyo, PhD f, g, Daniel Popkin, MD, PhD h, James P. Basilion, PhD a, c, d,
a Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 
b Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio 
c Department of Radiology, Case Western Reserve University, Cleveland, Ohio 
d National Foundation for Cancer Research Center for Molecular Imaging, Case Western Reserve University, Cleveland, Ohio 
e Akrotome Imaging Inc, Cleveland, Ohio 
f Department of Pathology, Stanford University, Stanford, California 
g Department of Microbiology and Immunology, Stanford University, Stanford, California 
h Department of Dermatology, University Hospital, Cleveland, Ohio 
i Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio 

Reprint requests: James P. Basilion, PhD, Departments of Biomedical Engineering, Radiology, and Pathology Case Center for Imaging Research, Case Western Reserve University, Wearn Bldg, Room B42, 11100 Euclid Ave, Cleveland, OH 44106-5056.Departments of Biomedical EngineeringRadiology, and Pathology Case Center for Imaging ResearchCase Western Reserve UniversityWearn BldgRoom B4211100 Euclid AveClevelandOH44106-5056

Abstract

Background

Mohs micrographic surgery examines all margins of the resected sample and has a 99% cure rate. However, many nonmelanoma skin cancers (NMSCs) are not readily amenable to Mohs micrographic surgery. This defines an unmet clinical need to assess the completeness of non-Mohs micrographic surgery resections during surgery to prevent re-excision/recurrence.

Objective

We sought to examine the utility of quenched activity-based probe imaging to discriminate cancerous versus normal-appearing skin tissue.

Methods

The quenched activity-based probe GB119 was applied to NMSC excised from 68 patients. We validated activation of the probe for hematoxylin-eosin–confirmed cancerous tissue versus normal-appearing skin tissue.

Results

Topical application of the probe differentiated basal cell carcinoma and squamous cell carcinoma from normal-appearing skin with overall estimated sensitivity and specificity of 0.989 (95% confidence interval 0.940-1.00) and 0.894 (95% confidence interval 0.769-0.965), respectively. Probe activation accurately defined peripheral margins of NMSC as compared with conventional hematoxylin-eosin–based pathology.

Limitations

This study only examined NMSC debulking excision specimens. The sensitivity and specificity for this approach using final NMSC excision margins will be clinically important.

Conclusions

These findings merit further studies to determine whether quenched activity-based probe technology may enable cost-effective increased cure rates for patients with NMSC by reducing re-excision and recurrence rates with a rapid and easily interpretable technological advance.

Le texte complet de cet article est disponible en PDF.

Graphical abstract




Le texte complet de cet article est disponible en PDF.

Key words : cathepsin-B, cathepsin-L, molecular optical imaging, nonmelanoma skin cancer, quenched activity-based probe, re-excision rate, topical application

Abbreviations used : BCC, H&E, IHC, MMS, NMSC, QABP, SCC, 2D


Plan


 This study was supported by an R21 (5R21CA183160-02) and P30 AR039750 award (Dr Basilion) and a subcontract to Dr Basilion from 5R21CA183160-02 awarded to Dr Straight of Akrotome Imaging Inc. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
 Disclosure: Drs Basilion and Bogyo are both board members and co-founders of Akrotome Imaging Inc. Dr Straight is the chief executive officer of Akrotome Imaging Inc. Drs Walker, Mann, Honda, Vidimos, Schluchter, and Popkin have no conflicts of interest to declare.
 eFigures and eTable are available at www.jaad.org.


© 2016  American Academy of Dermatology, Inc. Tous droits réservés.
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Vol 76 - N° 2

P. 209 - février 2017 Retour au numéro
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