Extemporaneous histological analysis according to slow-Mohs combined with Full-Field Optical Coherence Tomography evaluation (FFOCT) in cutaneous tumor pathology: Toward a digital extemporaneous analysis?

Abstract

Slow-Mohs micrographic surgery use is limited by the logistic constraints it imposes. Full-field optical coherence tomography (FFOCT) is an emerging non-invasive imaging technique that provides skin tissue imaging at the cellular level without tissue preparation. Evaluating the FFOCT technology's diagnostic possibilities in examining surgical sections in micrographic surgery for basal cell carcinomas compared to slow-Mohs. Two plastic surgeons provided 24 Mohs sections from 20 patients with basal cell carcinomas from a single-center. Each section was scanned using FFOCT, and a diagnosis-blinded pathologist reviewed the digital images for malignancy. The FFOCT images were compared with the standard histologic analysis of the sample sections. The agreement between FFOCT imaging results and slide histology included 17 true positives (VP) and 4 true negatives (TN) for debulking and 19 TN and 2 VP for Mohs peripheral cuts. The positive predictive value (PPV) was 85% for debulking, and the negative predictive value (NPV) was 100%. For recuts, the PPV was 50% and NPV was 95%. We developed a protocol for analyzing skin tumors ex vivo using FFOCT, providing digital images that can be transmitted remotely. This study serves as a proof of concept. The visualization of peripheral margins in a single image and the predictive values need to be improved before clinical use can be considered.