title: Rapid lump examination (RLE) - a new tool for Mohs surgery?
abstract: BACKGROUND
  "Micrographic surgery" spares tissue and results in fewer recurrences. Various techniques have been described using paraffin-embedded and cryostat sections or even optical sections from ex vivo confocal laser scanning microscopy. The presented technique is the rapid direct microscopy of the surface of a specimen (lump) for a pathological examination (RLE).
  
  
  METHODS
  Fresh surgical tissue was stained first without sectioning and then was examined directly under microscope. A 95 sec staining protocol for basal cell carcinoma (BCC) was established. 129 specimens were examined using a digital microscope and 78 specimens using a stereo microscope.
  
  
  RESULTS
  RLE had a high diagnostic accuracy compared to paraffin-embedded H&E-stained sections. Sensitivity and specificity of RLE was 91 % and 90 % for the digital and 90 % and 94 % for the stereo microscope. In addition we developed a 7 min RLE-immunohistology protocol using the BerEp4-antibody.
  
  
  CONCLUSIONS
  RLE is a simple and accurate technique for fresh tissue examination. Here, the technique has been established for BCC but the principle may also be transferred to histological bedside diagnosis of other tumors. The technique does not alter or destroy tissue, so that after RLE was done subsequent conventional histology is still possible. RLE might yield a time- and cost-saving diagnosis in micrographic surgery.
authors.affiliation: Universitäts-Hautklinik Tuebingen, Germany. matthias.moehrle@med.uni-tuebingen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Moehrle
authors.forename: Leila
authors.initials: L
authors.lastname: Käflein
authors.forename: Sarah
authors.initials: S
authors.lastname: Ziefle
authors.forename: Gisela
authors.initials: G
authors.lastname: Metzler
mesh_terms: D002280:Basal Cell Carcinoma / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004526:Efficiency; D006801:Humans; D015580:Mohs Surgery / Q000191:economics / Q000379:methods*; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000191:economics / Q000473:pathology; D016612:Paraffin Embedding / Q000191:economics; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery*; D013996:Time and Motion Studies