Margin diagnosis for endoscopic submucosal dissection of early gastric cancer using multiphoton microscopy.
Adenocarcinoma
/ diagnostic imaging
Aged
Aged, 80 and over
Double-Blind Method
Endoscopic Mucosal Resection
Female
Gastrectomy
/ methods
Humans
Male
Margins of Excision
Microscopy, Fluorescence, Multiphoton
Middle Aged
Pilot Projects
Prospective Studies
Sensitivity and Specificity
Stomach Neoplasms
/ diagnostic imaging
ESD
Early gastric cancer
Multiphoton microscopy
Resection margin
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
18
11
2018
accepted:
04
04
2019
pubmed:
12
4
2019
medline:
21
10
2020
entrez:
12
4
2019
Statut:
ppublish
Résumé
Endoscopic submucosal dissection (ESD) has become the primary option for the treatment of early gastric cancer (EGC). Thus, it is necessary to diagnose whether residual cancer cells exist in the ESD specimen margins, which can affect tumor recurrence and survival rates in the future. Multiphoton microscopy (MPM) can be suitably used for nondestructive imaging of biological tissue on a cellular level to enable real-time guidance during endoscopic therapy. Considering this, the objective of this study is to explore the practicality of MPM for the diagnosis of ESD specimen margins in the case of EGC. First, a total of 20 surgical samples was imaged using the proposed MPM technique to obtain two-photo excited fluorescence signal from the intrinsic fluorescent substances within cells and second-harmonic generation signal from collagen; these signals were used to determine MPM pathological features for margin diagnosis. Then, a double-blind study of 50 samples was conducted to evaluate the diagnosis results based on the obtained MPM pathological features. Multiphoton microscopy can accurately identify the cytological and morphological differences between tissue in the negative and positive margin. The sensitivity, specificity, accuracy, negative predictive, and positive predictive values of MPM in the diagnosis of ESD specimen margins were 97.62, 75.00, 94.00, 95.35, and 85.71%, respectively. These results indicate that MPM can be used as an effective, real-time, and label-free novel method to determine intraoperative resection margins.
Sections du résumé
BACKGROUND AND AIMS
Endoscopic submucosal dissection (ESD) has become the primary option for the treatment of early gastric cancer (EGC). Thus, it is necessary to diagnose whether residual cancer cells exist in the ESD specimen margins, which can affect tumor recurrence and survival rates in the future. Multiphoton microscopy (MPM) can be suitably used for nondestructive imaging of biological tissue on a cellular level to enable real-time guidance during endoscopic therapy. Considering this, the objective of this study is to explore the practicality of MPM for the diagnosis of ESD specimen margins in the case of EGC.
METHODS
First, a total of 20 surgical samples was imaged using the proposed MPM technique to obtain two-photo excited fluorescence signal from the intrinsic fluorescent substances within cells and second-harmonic generation signal from collagen; these signals were used to determine MPM pathological features for margin diagnosis. Then, a double-blind study of 50 samples was conducted to evaluate the diagnosis results based on the obtained MPM pathological features.
RESULTS
Multiphoton microscopy can accurately identify the cytological and morphological differences between tissue in the negative and positive margin. The sensitivity, specificity, accuracy, negative predictive, and positive predictive values of MPM in the diagnosis of ESD specimen margins were 97.62, 75.00, 94.00, 95.35, and 85.71%, respectively.
CONCLUSION
These results indicate that MPM can be used as an effective, real-time, and label-free novel method to determine intraoperative resection margins.
Identifiants
pubmed: 30972623
doi: 10.1007/s00464-019-06783-1
pii: 10.1007/s00464-019-06783-1
doi:
Types de publication
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
408-416Références
Surg Endosc. 2011 May;25(5):1425-30
pubmed: 21046158
Surg Endosc. 2011 Jun;25(6):1933-8
pubmed: 21136097
Endoscopy. 2004 Dec;36(12):1080-4
pubmed: 15578298
World J Gastroenterol. 2008 May 21;14(19):2962-7
pubmed: 18494043
Opt Commun. 2008 Apr 1;281(7):1823-1832
pubmed: 19343083
Sci Rep. 2015 Dec 17;5:18303
pubmed: 26673905
J Biomed Opt. 2009 May-Jun;14(3):034005
pubmed: 19566298
Aliment Pharmacol Ther. 2008 Oct 1;28(7):854-67
pubmed: 18637003
Endoscopy. 2005 Feb;37(2):178-82
pubmed: 15692936
Int J Cancer. 2015 Mar 1;136(5):E359-86
pubmed: 25220842
Cancer Res. 2005 Feb 15;65(4):1180-6
pubmed: 15735001
JAMA Dermatol. 2015 Oct;151(10):1068-74
pubmed: 25909650
Gastroenterology. 2010 Mar;138(3):834-42
pubmed: 19909747
J Natl Compr Canc Netw. 2013 May 1;11(5):531-46
pubmed: 23667204
Surg Endosc. 2014 Jan;28(1):36-41
pubmed: 24002915
ANZ J Surg. 2004 Mar;74(3):108-11
pubmed: 14996154
Proc Natl Acad Sci U S A. 2007 Dec 4;104(49):19494-9
pubmed: 18042710
J Gastroenterol Hepatol. 2010 Apr;25(4):712-8
pubmed: 20492327
Biomed Opt Express. 2011 Feb 16;2(3):615-9
pubmed: 21412466
Biomed Opt Express. 2018 Jul 24;9(8):3783-3793
pubmed: 30338155
Lancet. 2015 Mar 14;385(9972):977-1010
pubmed: 25467588
World J Gastroenterol. 2014 Dec 21;20(47):17993-8000
pubmed: 25548499
Proc Natl Acad Sci U S A. 2003 Jun 10;100(12):7075-80
pubmed: 12756303
Opt Express. 2006 Feb 6;14(3):1027-32
pubmed: 19503423