[1]崔倩,麻艺群,郭一俨,等.术前无创检测方法界定基底细胞癌边界的临床应用比较[J].中国皮肤性病学杂志,2019,(10):1135-1141.[doi:10.13735/j.cjdv.1001-7089.201808028]
 CUI Qian,MA Yiqun,GUO Yiyan,et al.The Clinical Significance of Non-invasive Methods in Determining the Margins of Basal Cell Carcinoma Prior to Surgery[J].The Chinese Journal of Dermatovenereology,2019,(10):1135-1141.[doi:10.13735/j.cjdv.1001-7089.201808028]
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术前无创检测方法界定基底细胞癌边界的临床应用比较
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《中国皮肤性病学杂志》[ISSN:1001-7089/CN:61-1197/R]

卷:
期数:
2019年10期
页码:
1135-1141
栏目:
临床经验
出版日期:
2019-09-13

文章信息/Info

Title:
The Clinical Significance of Non-invasive Methods in Determining the Margins of Basal Cell Carcinoma Prior to Surgery
文章编号:
1001-7089(2019)10-1135-07
作者:
崔倩麻艺群郭一俨李改赢蒋艳徐双云汤諹
昆明医科大学第一附属医院皮肤科,云南 昆明 650032
Author(s):
CUI QianMA YiqunGUO YiyanLI GaiyingJIANG YanXU ShuangyunTANG Yang
(Department of Dermatology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)
关键词:
基底细胞癌 边缘 皮肤镜 5-氨基酮戊酸 荧光定位 反射光共聚焦显微镜 高频超声 莫氏外科
Keywords:
Basal cell carcinoma Margin Dermoscopy 5-Aminolevulinic acid Fluorescence localization Reflectance confocal microscopy High frequency ultrasound Mohs micrographic surgery
分类号:
R 739.5
DOI:
10.13735/j.cjdv.1001-7089.201808028
文献标志码:
B
摘要:
目的 探究皮肤镜、5-氨基酮戊酸(5-aminolevulinic acid,ALA)荧光定位、反射光共聚焦显微镜(reflectance confocal microscopy,RCM)及高频超声无创检测方法检测基底细胞癌边界的可行性,为临床手术范围评估提供参考。方法 选取32例病理诊断为基底细胞癌(BCC)的患者,术前在无影灯下肉眼观察皮损大小,结合患者皮损情况及患者意愿使用皮肤镜、ALA荧光定位、RCM对病损及其边界进行观察并测量大小,高频B超测量浸润深度,后行手术切除,比较几种方法检测的肿瘤边界与肉眼观察边界、安全边界、切除肿瘤大小的差异,并进行统计学分析。结果 无影灯下肉眼观察、皮肤镜、ALA荧光定位、RCM检测的安全边界、手术切除大小两两相比,除皮肤镜与ALA荧光定位检测的大小差异无统计学意义外,其他差异均有统计学意义; 将皮肤镜、ALA荧光定位、RCM检测大小与切除肿瘤大小进行对比,其相关系数Pearson值分别为0.948、0.901、0.934; 手术切除大小分别在皮肤镜、ALA荧光定位、RCM检测大小基础上平均外扩2.93 mm、2.89 mm、1.41 mm; 术前经50 MHz高频超声测量浸润深度的4例BCC患者,手术切除后底壁均呈阴性。结论 对于BCC患者,术前根据患者不同皮损特点、病理类型及病损部位等恰当选择皮肤镜、ALA荧光或RCM观察和检测BCC的边界,以及使用50 MHz高频超声测量浸润深度能有效减少根据单纯手术扩切的盲目性,提高单次手术切净率,提高临床手术效率,降低手术风险。
Abstract:
Objective To explore the feasibility of detecting the margins of basal cell carcinoma(BCC)by microscopy,5-aminolevulinic acid(ALA)fluorescence localization,reflectance confocal microscopy(RCM)and high frequency ultrasound.Methods A total of 32 patients were diagnosed with BCC by pathology in combination with characteristics of lesions,the image of dermoscope, ALA fluoroscopy,and RCM to observe the lesions and to determine lesion margins.Following the measurement of depth of infiltration with high frequency ultrasound,surgical excision were performed.The tumor sizes measured with different methods were compared and analyzed with paired t test.Informed consent were obtained from patients.Results Tumor sizes were imomparable when measured with dermoscopy and ALA fluoroscopy.However, tumor sizes differed significantly in any other measurement methods.Pearson coefficients between surgical size of the tumor and dermoscopy,ALA fluoroscopy,and RCM were 0.948,0.901,and 0.934,respectively.The final resection sizes were extended to 2.93 mm,2.89 mm,and 1.41 mm from the margins defined by dermoscopy,ALA fluoroscopy and RCM,respectively.Pathologic examination of samples from the bottom of resected tumors showed no tumor cells in 4 patients examined with 50 MHz high frequency ultrasound before operation.Conclusion According to the characteristics of lesions,prior to resection determination of margins of tumor with dermoscopy,ALA fluoroscopy,RCM or high frequency ultrasound to identify the margins of BCC could reduce risks of operation and improve working efficiency.

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备注/Memo

备注/Memo:
[作者单位] 昆明医科大学第一附属医院皮肤科,云南 昆明 650032
[通讯作者] 汤諹,E-mail:drtangyang@126.com
更新日期/Last Update: 2019-09-12