Confocal Laser Endomicroscopy in the Diagnostics of Malignancy of the Gastrointestinal Tract
Authors:
P. Moravčík 1; J. Hlavsa 1; L. Kunovsky 1,2; Z. Kala 1; I. Penka 1
; M. Dastych 2
Authors place of work:
Chirurgická klinika LF MU a FN Brno
1; Interní gastroenterologická klinika LF MU a FN Brno
2
Published in the journal:
Klin Onkol 2017; 30(4): 258-263
Category:
Review
doi:
https://doi.org/10.14735/amko2017258
Summary
In confocal laser endomicroscopy (CLE), a type of optical microscope that uses a laser beam as its light source and processes the acquired image by processor unit is used. Although the principle behind the device has been known since 1957, its use in clinical practice has only recently been enabled by technical developments, and it is therefore a relatively new modality in differential diagnosis. CLE enables real-time microscopic imaging of the tissue under investigation and in fact non-invasive in vivo biopsy. First experiences with CLE have primarily been obtained in the field of endoscopy, in particular in the pathology of the esophagus, stomach, bile duct, pancreas, and colon. Further to its use in endoscopy, CLE was recently developed for perioperative use, with the most experience gained in neurological, breast, and prostate surgery. Numerous prospective randomized trials have confirmed the benefits of CLE in tumor screening, differential diagnosis of tumors or inflammatory diseases, earlier diagnostics of diseases, and reducing the number of required endoscopic examinations. In addition, CLE is associated with minimal side effects. A known possible side effect is allergy to the fluorescein used to stain tissues during the examination. Extending of endoscopic examination or surgery is minimal in the hands of trained personnel. Current limiting factors of CLE include insufficient clinical experience, the price of the CLE device and probes, and the subjectivity inherent in the evaluation of microscopic images by the endoscopist or surgeon. This article summarizes published studies of CLE in the diagnostics of oncological diseases of the gastrointestinal tract.
Key words:
confocal microscopy – gastrointestinal tract – neoplasms
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
Submitted:
9. 2. 2017
Accepted:
26. 2. 2017
Zdroje
1. Minsky M. Memoir on inventing the confocal scanning microscope. Scanning 1988; 10 (4): 128–138. doi: 10.1002/sca.4950100403.
2. Petráň M, Hadravský M, Boyde A. The tandem scanning reflected light microscope. Scanning 1985; 7 (2): 97–108. doi: 10.1002/sca.4950070205.
3. Petráň M, Hadravský M, Beneš J et al. In Vivo Microscopy Using the Tandem Scanning Microscope. Annals of the New York Academy of Sciences 1986; 483 (1): 440–447. doi: 10.1111/j.1749-6632.1986.tb34554.x.
4. Fellers T, Davidson M (eds). Introduction to Confocal Microscopy [online]. Olympus Microscopy Resource Center | Confocal Microscopy – Introduction [cited 2017 Jan 9]. Available from: http://www.olympusmicro.com/primer/techniques/confocal/confocalintro.html.
5. Paddock SW. Principles and practices of laser scanning confocal microscopy. Mol Biotechnol 2000; 16 (2): 127–149. doi: 10.1385/MB: 16: 2: 127.
6. Lagali N (ed.). Confocal Laser Microscopy – Principles and Applications in Medicine, Biology, and the Food Sciences [online]. Rijeka: InTech; 2013 [cited 2016 Nov 8]. Available from: http: //www.intechopen.com/books/confocal-laser-microscopy-principles-and-applications-in-medicine-biology-and-the-food-sciences/confocal-endomicroscopy.
7. Chauhan S, Dayyeh B, Bhat YM et al. Confocal laser endomicroscopy. Gastrointest Endosc 2014; 80 (6): 928–938. doi: 10.1016/j.gie.2014.06.021.
8. Wallace MB, Meining A, Canto MI et al. The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract. Aliment Pharm Therap 2010; 31 (5): 548–552. doi: 10.1111/j.1365-2036.2009.04207.x.
9. Černoch J (ed.). Prekancerózy v trávicím traktu. 1. vyd. Praha: Grada 2012.
10. Buchner AM, Gomez V, Heckman MG et al. The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia. Gastrointest Endosc 2011; 73 (3): 556–560. doi: 10.1016/j.gie.2011.01.002.
11. Martínek J, Zavoral M. Barrettův jícen – jak sledovat a jak léčit. Postgrad Med 2009; 11 (6): 674–682.
12. Neumann H, Fujishiro M, Wilcox CM et al. Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology. Dig Endosc 2014; 26 (Suppl 1): 43–51. doi: 10.1111/den.12190.
13. Sharma P, Mcquaid K, Dent J et al. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology 2004; 127 (1): 310–330. doi: 10.1053/j.gastro.2004.04.010.
14. Spechler SJ, Sharma P, Souza RF et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011; 140 (3): 18–52. doi: 10.1053/j.gastro.2011.01.031.
15. Canto MI, Anandasabapathy S, Brugge W et al. In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 2014; 79 (2): 211–221. doi: 10.1016/j.gie.2013.09.020.
16. Sharma P, Meining AR, Coron E et al. Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011; 74 (3): 465–472. doi: 10.1016/j.gie.2011.04.004.
17. Rejchrt S. Diagnostika cystických tumorů pankreatu [online]. [citováno 9. ledna 2017]. Dostupné z: http://www.hpb.cz/index.php?pId=07-1-10.
18. Brugge WR, Lewandrowski K, Lee-Lewandrowski E et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126 (5): 1330–1336. doi: 10.1053/j.gastro.2004.02.013.
19. Konda VJ, Meining A, Jamil LH et al. Mo1204 An International, Multi-Center Trial on Needle-Based Confocal Laser Endomicroscopy (nCLE): Results From the In Vivo CLE Study in the Pancreas With Endosonography of Cystic Tumors (INSPECT). Gastroenterology 2012; 142 (5 Suppl 1): S620–S621. doi: 10.1016/S0016-5085 (12) 62384-1.
20. Napoléon B, Lemaistre AI, Pujol B et al. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy 2015; 47 (1): 26–32. doi: 10.1055/s-0034-1390693.
21. Nakai Y, Iwashita T, Park DH et al. Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015; 81 (5): 1204–1214. doi: 10.1016/j.gie.2014.10.025.
22. Fogel EL, Debellis M, Mchenry L et al. Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. Gastrointest Endosc 2006; 63 (1): 71–77. doi: 10.1016/j.gie.2005.08.039.
23. De Bellis M, Sherman S, Fogel EL et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 1). Gastrointest Endosc 2002; 56 (4): 552–561. doi: 10.1016/S0016-5107 (02) 70442-2.
24. Gerhards MF, Vos P, van Gulik TM et al. Incidence of benign lesions in patients resected for suspicious hilar obstruction. Br J Surg 2001; 88 (1): 48–51. doi: 10.1046/j. 1365-2168.2001.01607.x.
25. Slivka A, Gan I, Jamidar P et al. Validation of the diag-nostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study. Gastrointest Endosc 2015; 81 (2): 282–290. doi: 10.1016/j.gie.2014.10.009.
26. Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 2008; 43 (9): 641–651. doi: 10.1007/s00535-008-2223-4.
27. Tanaka S, Sano Y. Aim to unify the narrow band imaging (NBI) magnifying classification for colorectal tumors: current status in Japan from a summary of the consensus symposium in the 79th annual meeting of the Japan gastroenterological endoscopy society: NBI magnification for colorectal tumor. Dig Endosc 2011; 23 (Suppl 1): 131–139. doi: 10.1111/j.1443-1661.2011.01106.x.
28. Hewett DG, Kaltenbach T, Sano Y et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143 (3): 599–607. doi: 10.1053/j.gastro.2012.05.006.
29. Khashab M, Eid E, Rusche M et al. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 2009; 70 (2): 344–349. doi: 10.1016/j.gie.2008.10. 037.
30. Shahid MW, Buchner AM, Coron E et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy in detecting residual colorectal neoplasia after EMR: a prospective study. Gastrointest Endosc 2012; 75 (3): 525–533. doi: 10.1016/j.gie.2011.08.024.
31. Pierangelo A, Fuks D, Benali A et al. Diagnostic accuracy of confocal laser endomicroscopy for the ex vivo characterization of peritoneal nodules during laparoscopic surgery. Surg Endosc 2017; 31 (4): 1974. doi: 10.1007/s00464-016-5172-7.
32. Chang TP, Leff DR, Shousha S et al. Imaging breast cancer morphology using probe-based confocal laser endomicroscopy: towards a real-time intraoperative imaging tool for cavity scanning. Breast Cancer Res Treat 2015; 153 (2): 299–310. doi: 10.1007/s10549-015-3543-8.
33. De Palma GD, Esposito D, Luglio G et al. Confocal laser endomicroscopy in breast surgery: a pilot study. BMC Cancer 2015; 15: 252. doi: 10.1186/s12885-015-1245-6.
34. Charalampaki P, Javed M, Daali S et al. Confocal laser endomicroscopy for real-time histomorphological diagnosis: our clinical experience with 150 brain and spinal tumor cases. Neurosurgery 2015; 62 (Suppl 1): 171–176. doi: 10.1227/NEU.0000000000000805.
35. Mooney MA, Zehri AH, Georges JF et al. Laser scanning confocal endomicroscopy in the neurosurgical operating room: a review and discussion of future applications. Neurosurg Focus 2014; 36 (2): E9. doi: 10.3171/2013.11.FOCUS13484.
36. Lopez A, Zlatev DV, Mach KE et al. Intraoperative optical biopsy during robotic assisted radical prostatectomy using confocal endomicroscopy. J Urol 2016; 195 (4): 1110–1117. doi: 10.1016/j.juro.2015.10.182.
37. Moravčík P, Hlavsa J. Konfokální mikroskopie při operacích karcinomu pankreatu. Sborník abstrakt XL. brněnských onkologických dnů a XXX. konference pro nelékařské zdravotnické pracovníky. Klin Onkol 2016; 29 (Suppl 2): 2S91.
Štítky
Paediatric clinical oncology Surgery Clinical oncologyČlánok vyšiel v časopise
Clinical Oncology
2017 Číslo 4
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
- Current Insights into the Antispasmodic and Analgesic Effects of Metamizole on the Gastrointestinal Tract
- Obstacle Called Vasospasm: Which Solution Is Most Effective in Microsurgery and How to Pharmacologically Assist It?
Najčítanejšie v tomto čísle
- Reactive Lymphoid Hyperplasia of the Liver
- Metastatic Pituitary Disorders
- Radiotherapy of Lung Tumours in Idiopathic Pulmonary Fibrosis
- Radiation Necrosis in the Upper Cervical Spinal Cord in a Patient Treated with Proton Therapy after Radical Resection of the Fourth Ventricle Ependymoma