Figure 2
From: In vivo optical imaging-guided targeted sampling for precise diagnosis and molecular pathology
Targeted 1-mm biopsy enables diagnosis, feature and depth correlation, and molecular pathology. A. Diagnosis and Feature Correlation. (a) Clinical photograph after placing 1-mm grid on a suspected pigmented-BCC (green-box shows targeted-biopsy location following RCM), (b) RCM image shows tumor nests with bright cells inside and peripherally, confirming BCC diagnosis (metallic grid lines in RCM shown by red-arrows); (c) magnified view of the yellow-square shows bright cells (within cyan-hoops) inside and peripherally to tumor nests with inset photograph demonstrating 1-mm targeted-biopsy for RCM-histopathology correlation; (d) frozen histopathology (40x, scale bar = 25 µm) confirms bright cells as melanophages and melanocytes inside and peripheral to BCC nests. Depth correlation. (e) RCM imaging of suspected keratinocytic tumor revealed nests with peripheral palisading (yellow-asterisk) emanating from epidermis, confirming the diagnosis of BCC; (f) the same nests visualized in the superficial dermis on the spatially-registered OCT image with maximum depth measured to be ~ 180 µm; (g) precision biopsy followed by vertical sectioning confirmed the RCM-OCT diagnosis and depth. Molecular Pathology. (h) Clinical photograph of large invasive melanoma with metallic grid (green-box shows targeted-biopsy location following RCM) and dermoscopic photograph as inset (silver area in inset corresponds to grid placement); (i) Low density of melanoma cells (orange-boxes) inside tissue volume in area 1, (j) high density of melanoma cells (yellow-boxes) in area 2; (k) magnified RCM image highlighting the large atypical melanocytes in area 2; (l) Targeted 1-mm biopsy from area 2 yielded non-fragmented high-quality DNA (A1, sample) with DNA integrity number (DIN) value of 8.0 and total amount 680 ng which were successfully analyzed with IMPACT505-mutational profiling. These cases illustrate that high-resolution imaging-guided precision biopsy with 1-mm sampling allows correlation of the micron-level features and tumor depth with histopathology and yields adequate quantity and quality of DNA for molecular profiling.
