Preoperative Use Of Reflective Confocal Microscopy To Define The Extra-abdominal Paget Disease Boundary For The Precise Resection Of Tumors

Objective:Discuss the role of reflectance confocal microscopy mapping tumor boundaries in extramammary paget disease surgical treatment.Methods:We recruited 13 pathologically diagnosed EMPD patients and mapped the lesions with reflectance confocal microscopy before surgery.Before examinations,3%boric acid solution,ethacridine lactate paste and prednisone were applied to patients with severe exudation,erosion,crust.Areas around lesions were shaved in advance.Patients lied down bending knees and hips.We determined the opposite side of RCM len as inner and outer sides corresponding to the lesion.According to the specific image of paget cell and the atypia of tumor tissue,we delineated the tumor in order,biopsies were obtained for pathology.Surgeries were operated based on the RCM margin,post-surgical pathology tests were used to verify the accuracy.In the meantime,we analyzed the post-surgical pathology results of EMPD patients and compared those with our recruiters.Results:10 out of 13(76.9%)patients were pathologically affirmed with clear margins,while 27 out of 50(54%)patients in control group were pathologically clean.3(23.1%)patients were pathologically verified with tumor residual,in contrast to 23(54%)tumor pathologically positive of control groups.Less accuracy of RCM is observed at scrotum.Conclusions:There's an obvious difference between recruiters and control groups in surgical efficacy.In comparison to traditional extensive excision,surgeries based on RCM boundaries indicate better accuracy.