Preoperative tumor mapping using handheld optical coherence tomography in periocular basal cell carcinoma
Author: Sveina Björk Karlsdóttir Base Hospital / Institution: Department of Ophthalmology, University Hospital of Southern Denmark.ePoster presentation
Abstract ID: 26-140Purpose
To evaluate the effectiveness of skin optical coherence tomography (OCT) for tumor mapping, particularly in periocular basal cell carcinomas (BCC) to improve surgical planning, tissue preservation and reduce duration of the surgical procedure.
Methods
This study included consecutive patients with clinically suspected periocular BCC at a tertiary referral center. All patients underwent bedside OCT before biopsy, with a second OCT performed for preoperative mapping in confirmed BCCs. Each patient was scanned by two independent ophthalmologists using either standard or customized OCT probes; scans were also evaluated by a blinded dermatologist. Histopathology was the reference standard. Of 210 included, 141 had BCC and were eligible for tumor mapping; 135 underwent surgery. Due to logistical constraints, mapping was feasible in 66 patients, with 61 undergoing preoperative OCT to date.
Results
Among 61 patients, 45 had tumor-free surgical margins after first resection. Fifteen had involved margins, including one case reclassified as involved after re-evaluation; and one case was uncertain. Using standard OCT, free surgical margins were correctly identified in 31/45 cases; assessment in the majority of the remaining cases was limited by image quality. Involved margins at corresponding clock-hour locations were correctly identified in 7/15 cases and suspected to be involved in four additional cases with lower diagnostic confidence. Importantly, no involved margins were classified as tumor-free with sufficient confidence to omit frozen section analysis. In five cases, OCT and histopathology indicated a wide distance to the tumor margin. Diagnostic confidence increased over time, indicating a learning curve.
Conclusion
OCT has potential for preoperative bedside tumor mapping, correctly identifying involved margins in 47% of cases. No high-confidence false-negative assessments were observed. OCT may enable safe and more precise surgical planning and tissue-sparing surgery in the periocular region. Further standardization of scanning procedures and increased experience may improve performance.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Flemming | Møller | Department of Ophthalmology, University Hospital of Southern Denmark. |
| Nikolaj Carsting | Bjerrum | Department of Ophthalmology, University Hospital of Southern Denmark. |
| Mette | Mogensen | Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Denmark |
| Steffen | Heegaard | Department of Ophthalmology, Rigshospitalet–Glostrup, Copenhagen University Hospital, Denmark |
| Kim Døvling | Lindahl | Department of Pathology, University Hospital of Southern Denmark |
