Fluorescence Confocal Microscopy for Ex Vivo Diagnosis of Conjunctival Tumors: A Pilot Study.
To evaluate the potential use of fluorescence confocal microscopy (FCM) for ex vivo diagnosis and excision margin assessment of conjunctival neoplasms.



Validity study.



setting: Single institution.



Consecutive patients with clinically suspicious conjunctival lesions.



Conjunctival lesions were excised in toto using a standard "no-touch technique" by a single surgeon (A.I.). Collected specimens were examined with a commercially available laser scanning fluorescence confocal microscope after immersion in a 0.6 mM solution of acridine orange dye for 10-20 seconds. Specimens were subsequently processed with standard histologic analysis.



FCM diagnosis of the nature and extension of conjunctival lesions.



Sixteen consecutive patients were included in the study (11 male, 5 female; mean age 58.1 ± 26.1 years, range 10-90 years). The median time needed to process and analyze a sample with FCM was 15 minutes. Eleven of 16 lesions were identified by FCM as squamous (2 benign papillomas, 2 grade 2 conjunctival intraepithelial neoplasias, 7 in situ squamous carcinomas) and 5 as nonsquamous (1 pingueculum, 1 dermolipoma, 2 melanocytic nevi, 1 melanoma). In all cases FCM was able to detect horizontal and vertical extension of the lesion. All FCM findings were confirmed by corresponding subsequent histologic examination.



FCM provides a fast ex vivo preliminary diagnosis of suspicious conjunctival lesions with good histologic details and margin assessment, and may represent a novel tool for intraoperative and postsurgical management of conjunctival tumors. This is the first study to investigate ex vivo FCM application in ophthalmology.
Department of Ophthalmology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy. Electronic address: alfonsoiovieno@hotmail.com.
Alfonso
A
Iovieno
Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Caterina
C
Longo
Department of Ophthalmology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Mariacarla
M
De Luca
Department of Pathology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Simonetta
S
Piana
Department of Ophthalmology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Luigi
L
Fontana
Department of Pathology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Moira
M
Ragazzi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis; D002648:Child; D003230:Conjunctival Neoplasms / Q000175:diagnosis*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D010212:Papilloma / Q000175:diagnosis; D010865:Pilot Projects; D055815:Young Adult