scholarly journals Morphometric Assessment of Confocal Laser Endomicroscopy for Pancreatic Ductal Adenocarcinoma, an Ex-Vivo Pilot Study

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 923
Author(s):  
Bogdan Silviu Ungureanu ◽  
Daniel Pirici ◽  
Simona Olimpia Dima ◽  
Irinel Popescu ◽  
Gheorghe Hundorfean ◽  
...  
Keyword(s):  
Image Analysis ◽  
Pilot Study ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ex Vivo ◽  
Ductal Adenocarcinoma ◽  
Confocal Laser Endomicroscopy ◽  
Resection Margins ◽  
Confocal Laser ◽  
Cross Sectional ◽  
Hole Area

Ex-vivo freshly surgical removed pancreatic ductal adenocarcinoma (PDAC) specimens were assessed using pCLE and then processed for paraffin embeding and histopathological diagnostic in an endeavour to find putative image analysis algorithms that might recognise adenocarcinoma. Methods: Twelve patients diagnosed with PDAC on endoscopic ultrasound and FNA confirmation underwent surgery. Removed samples were sprayed with acriflavine as contrast agent, underwent pCLE with an experimental probe and compared with previous recordings of normal pancreatic tissue. Subsequently, all samples were subjected to cross-sectional histopathology, including surgical resection margins for controls. pCLE records, as well as corespondant cytokeratin-targeted immunohistochemistry images were processed using the same morphological classifiers in the Image ProPlus AMS image analysis software. Specific morphometric classifiers were automatically generated on all images: Area, Hole Area (HA), Perimeter, Roundness, Integrated Optical Density (IOD), Fractal Dimension (FD), Ferret max (Fmax), Ferret mean (Fmean), Heterogeneity and Clumpiness. Results: After histopathological confirmation of adenocarcinoma areas, we have found that the same morphological classifiers could clearly differentiate between tumor and non-tumor areas on both pathology and correspondand pCLE (area, roundness, IOD, ferret and heterogeneity (p < 0.001), perimeter and hole area (p < 0.05). Conclusions: This pilot study proves that classical morphometrical classifiers can clearly differentiate adenocarcimoma on pCLE data, and the implementation in a live image-analysis algorithm might help in improving the specificity of pCLE in vivo diagnostic.

scholarly journals The clinical evaluation of needle-based confocal laser endomicroscopy in the assessment of pancreatic cystic lesion: A pilot study

2017 ◽  
Vol 27 (2) ◽  
pp. 96-102
Author(s):  
Yung Ka Chin ◽  
Christopher Jen Lok Khor ◽  
Brian Kim Poh Goh ◽  
Tony Kiat Hon Lim ◽  
Damien Meng Yew Tan
Keyword(s):  
Adverse Event ◽  
Diagnostic Yield ◽  
Pancreatic Neuroendocrine Tumor ◽  
Final Diagnosis ◽  
Ductal Adenocarcinoma ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
High Morbidity ◽  
Cystic Lesions ◽  
Cross Sectional

Background/aim: Pancreatic cystic lesions are increasingly diagnosed from cross-sectional imaging done for other indications. The challenge lies in the ability to correctly identify the high-risk individuals for resection surgery, which carries high morbidity and mortality. Unfortunately, present diagnostic techniques are suboptimal. Needle-based confocal laser endomicroscopy (nCLE) has been designed to bridge this diagnostic gap. We aim to assess the feasibility and safety of nCLE in the assessment of pancreatic cystic lesions. Methods: We prospectively recruited patients referred for assessment of pancreatic cystic lesions from August 2014 until July 2015. All pancreatic cystic lesions were examined with nCLE miniprobe via endoscopic ultrasound followed by fine-needle aspiration. Information regarding the cysts (morphology, location, fluid analysis etc.) was documented. Adverse event was recorded. Results: Fourteen patients were recruited, six were male with a mean age of 66.5 (range 48–80) years. Only 12 completed nCLE examination of the pancreatic cystic lesions. nCLE imaging was successful in 83.3% (10/12). Average nCLE imaging duration was 5 min 18 s. There was one (10%) adverse event. nCLE impressions were correct in eight cases (five malignant and three benign) compared with final diagnosis. Three patients underwent surgery, histology showed ductal adenocarcinoma, pancreatic neuroendocrine tumor and gastric-subtype of intraductal papillary mucinous neoplasm. The sensitivity and specificity of the nCLE impression when compared with final diagnosis were 83.3% and 75% respectively. The accuracy of nCLE was 80%. Conclusion: Our results have demonstrated that nCLE assessment of pancreatic cystic lesions is safe and feasible. It may complement the existing diagnostic modalities to improve diagnostic yield.

Imaging of pancreatic cystic lesions with confocal laser endomicroscopy: an ex vivo pilot study

2017 ◽  
Vol 31 (12) ◽  
pp. 5119-5126 ◽  
Author(s):  
Abdurrahman Kadayifci ◽  
Mustafa Atar ◽  
Michelle Yang ◽  
Carlos Fernandez-del Castillo ◽  
Mari Mino-Kenudson ◽  
...  
Keyword(s):  
Pilot Study ◽  
Ex Vivo ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cystic Lesions

Confocal Laser Endomicroscopy of Bladder Tumors Associated With Photodynamic Diagnosis: An Ex Vivo Pilot Study

Urology ◽  
2012 ◽  
Vol 80 (5) ◽  
pp. 1162.e1-1162.e5 ◽  
Author(s):  
Jean-Louis Bonnal ◽  
Aurélien Rock ◽  
Antoine Gagnat ◽  
Stephanos Papadopoulos ◽  
Bernard Filoche ◽  
...  
Keyword(s):  
Pilot Study ◽  
Ex Vivo ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Photodynamic Diagnosis ◽  
Bladder Tumors

Confocal laser microscopy without fluorescent dye in minimal-invasive thoracic surgery: an ex-vivo pilot study in lung cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
David Benjamin Ellebrecht ◽  
Christiane Kuempers ◽  
Sven Perner ◽  
Christian Kugler ◽  
Markus Kleemann
Keyword(s):  
Lung Cancer ◽  
Pilot Study ◽  
Ex Vivo ◽  
Minimal Invasive ◽  
Fluorescent Dye ◽  
Resection Margins ◽  
Confocal Laser ◽  
Pulmonary Tissue ◽  
Healthy Lung Tissue ◽  
Healthy Lung

AbstractCancer will be the leading cause of death in a few decades. In line with minimal invasive lung cancer surgery, surgeons loose most of their tactile tissue information and need an additional tool of intraoperative tissue navigation during surgery. Confocal laser microscopy is a well-established method of tissue investigation. In this ex-vivo pilot study, we evaluated an endoscopic confocal laser microscope (eCLM) that does not need any fluorescent dye as a diagnostic tool in non-malignant and malignant pulmonary tissue and distal stapler resection margins, respectively. In seven cases, an eCLM was used for examining pulmonary tissue ex-vivo. Images of non-malignant and non-small cell lung cancer tissue and distal stapler resection margins were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described. Healthy lung tissue showed hyperreflectoric alveolar walls with dark alveolar spaces. Hyperreflective nets indicated the tumor stroma; whereas the hyperreflective areas indicated the tumor cell clusters. Compared to adenocarcinoma tissue, tissue from squamous cell carcinoma showed more distinctive hyperreflective stroma nets. eCLM characteristics seen in non-malignant and malignant tissue were also visible in distal stapler resection margins and so therefore it was feasible to distinguish between healthy lung tissue and lung cancer. This pilot study shows that the assessment of pulmonary tissue with this eCLM for minimally invasive surgical approach without any fluorescent dye is feasible. It enables to differentiate between benign and malignant tissue in pulmonary specimen by easy to evaluate and reproducible parameters.

scholarly journals Fluorescein- and EGFR-Antibody Conjugated Silica Nanoparticles for Enhancement of Real-time Tumor Border Definition Using Confocal Laser Endomicroscopy in Squamous Cell Carcinoma of the Head and Neck

Nanomaterials ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. 1378 ◽  
Author(s):  
Anna Watermann ◽  
Rita Gieringer ◽  
Anna-Maria Bauer ◽  
Sven Kurch ◽  
Ralf Kiesslich ◽  
...  
Keyword(s):  
Head And Neck ◽  
Silica Nanoparticles ◽  
Laser Scanning ◽  
Ex Vivo ◽  
Tumor Resection ◽  
Laser Scanning Microscopy ◽  
Confocal Laser Endomicroscopy ◽  
Resection Margins ◽  
Confocal Laser ◽  
Definition Of

Intraoperative definition of tumor free resection margins in head and neck cancer is challenging. In the current proof-of-principle study we evaluated a novel silica nanoparticle-based agent for its potential use as contrast enhancer. We synthesized silica nanoparticles with an average size of 45 nm and modified these particles with the fluorescence stain fluorescein isocyanate (FITC) for particle detection and with epidermal growth factor receptor (EGFR)-targeting antibodies for enhanced tumor specificity. The nanoparticles exhibited good biocompatibility and could be detected in vitro and in vivo by confocal laser scanning microscopy. Additionally, we show in an ex vivo setting that these modified nanoparticles specifically bind to tumor samples and could be detected using a handheld confocal fluorescence endomicroscope. From a clinical point of view, we believe that this method could be used for tumor border contrast enhancement and for better intraoperative definition of R-0 tumor resection.

Predicting Surgical Margins in Patients With Borderline Resectable and Locally Advanced Pancreatic Cancer Undergoing Resection

2021 ◽  
pp. 000313482110111
Author(s):  
Weizheng Ren ◽  
Dimitrios Xourafas ◽  
Stanley W. Ashley ◽  
Thomas E. Clancy
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Borderline Resectable ◽  
Stepwise Selection ◽  
R1 Resection ◽  
Positive Resection Margins

Background Many patients with borderline resectable/locally advanced pancreatic ductal adenocarcinoma (borderline resectable [BR]/locally advanced [LA] pancreatic ductal adenocarcinoma [PDAC]) undergoing resection will have positive resection margins (R1), which is associated with poor prognosis. It might be useful to preoperatively predict the margin (R) status. Methods Data from patients with BR/LA PDAC who underwent a pancreatectomy between 2008 and 2018 at Brigham and Women’s Hospital were retrospectively reviewed. Logistic regression analysis was used to evaluate the association between R status and relevant preoperative factors. Significant predictors of R1 resection on univariate analysis ( P < .1) were entered into a stepwise selection using the Akaike information criterion to define the final model. Results A total of 142 patients with BR/LA PDAC were included in the analysis, 60(42.3%) had R1 resections. In stepwise selection, the following factors were identified as positive predictors of an R1 resection: evidence of lymphadenopathy at diagnosis (OR = 2.06, 95% CI: 0.99-4.36, P = .056), the need for pancreaticoduodenectomy (OR = 3.81, 96% CI: 1.15-15.70, P = .040), extent of portal vein/superior mesenteric vein involvement at restaging (<180°, OR = 3.57, 95% CI: 1.00-17.00, P = .069, ≥180°, OR = 7,32, 95% CI: 1.75-39.87, P = .010), stable CA 19-9 serum levels (less than 50% decrease from diagnosis to restaging, OR = 2.27, 95% CI: 0.84-6.36 P = .107), and no preoperative FOLFIRINOX (OR = 2.17, 95% CI: 0.86-5.64, P = .103). The prognostic nomogram based on this model yielded a probability of achieving an R1 resection ranging from <5% (0 factors) to >70% (all 5 factors). Conclusions Relevant preoperative clinicopathological characteristics accurately predict positive resection margins in patients with BR/LA PDAC before resection. With further development, this model might be used to preoperatively guide surgical decision-making in patients with BR/LA PDAC.

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