Peroral cholangioscopy-guided probe-based confocal laser endomicroscopy for preoperative diagnosis of pancreatic cancer in a patient with surgically altered anatomy.
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ABSTRACT:
SUBMITTER: Tanisaka Y
PROVIDER: S-EPMC7058530 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:We encountered a case of wall thickening of the bile duct in a 69-year-old man. endoscopic retrograde cholangiopancreatography (ERCP) was performed for detailed examination. When an area considered to be the healthy bile duct was examined by peroral cholangioscopes (POCS) (SPYGlass DS), the vascular network was observed. POCS-guided, probe-based confocal laser endomicroscopy (pCLE; CholangioFlex, Cellvizio; Mauna Kea Technologies, Paris, France), performed using the fluorescein-dripping method on this area, showed a reticular network of thin dark branching bands, which were presumed to be a collagen bundle or lymphatic vessels according to the Miami Classification. However, 8 ?m-diameter objects thought to be red blood cells were observed inside the bands, which were considered to correspond to the vascular network observed on POCS. A biopsy specimen of this site was taken. The histological examination demonstrated capillaries just beneath the bile duct epithelium. Thus, the histology also suggested the presence of the vascular network. In this study, we obtained findings that cannot be explained in terms of the Miami Classification, which we describe here with a video.
| S-EPMC7273719 | biostudies-literature
Project description:BackgroundThe accurate diagnosis of biliary strictures remains problematic. The aim of the present study was to prospectively evaluate the clinical utility of probe-based confocal laser endomicroscopy (pCLE) under the direct view of peroral cholangioscopy (POCS) for the diagnosis of biliary strictures.MethodsConsecutive patients with biliary strictures were included. We investigated sensitivity, specificity, and accuracy to diagnose malignancy for (1) ERCP alone, (2) POCS, (3) pCLE under the direct view of POCS, and (4) tissue sampling under the direct view of POCS.ResultsA total of 30 patients (17 with malignant lesions) were prospectively enrolled. (1) ERCP alone showed 88.2% sensitivity, 46.2% specificity, and 70% (95% confidence interval (CI), 52.1%-83.3%) accuracy. (2) POCS showed 100% sensitivity, 76.9% specificity, and 90% (95% CI, 74.4%-96.5%) accuracy. (3) pCLE under the direct view of POCS showed 94.1% sensitivity, 92.3% specificity, and 93.3% (95% CI, 78.7%-98.8%) accuracy. (4) Tissue sampling under the direct view of POCS showed 82.4% sensitivity, 100% specificity, and 90% (95% CI, 74.4%-96.5%) accuracy.ConclusionspCLE under the direct view of POCS provided highly accurate and sensitive characterization of biliary strictures and showed the potential for more diagnostic reliability and reduction of delays in diagnosis. This trial was registered at UMIN (registration number: UMIN000033801).
| S-EPMC7790558 | biostudies-literature
Project description:Background and objectiveProbe based confocal laser endomicroscopy (pCLE) is an optical imaging technique allowing live tissue imaging at a cellular level. Currently, this tool remains experimental. Two studies regarding pleural disease have been published and suggest that pCLE could be valuable for pleural disease investigations. However, normal and malignant pleural pCLE features remain unknown. Therefore, we conducted a prospective trial of pCLE during medical thoracoscopy to study and describe the malignant and benign pleural pCLE features.MethodsEvery patient >18?years referred to our department for medical thoracoscopy was eligible. Medical thoracoscopy was performed under sedation, allowing spontaneous breathing. Five millilitres of fluorescein (10%) was intravenously administrated 5?min before image acquisition. The pCLE was introduced through the working channel of the thoracoscope and gently placed on the parietal pleura to record videos. Afterwards, biopsies were performed on the corresponding sites. Malignant and benign pleural pCLE features were precisely described and compared using 11 preselected criteria.ResultsA total of 62 patients were included in the analysis including 36 benign and 26 malignant pleura. Among our preselected criteria, 'abnormal tissue architecture' and 'dysplastic vessels' were strongly associated with malignancies (100% and 85% ss, 721% and 74% sp, respectively) whereas, the 'full chia seeds sign' and 'cell shape homogeneity' were associated with benignity (36% and 56% ss, 100% and 70% sp, respectively). No study-related adverse events occurred.ConclusionBenign and malignant pleural involvement have clearly distinct pCLE features.
| S-EPMC7891618 | biostudies-literature
Project description:RATIONALE:Probe-based confocal endomicroscopy provides real time videos of autoflourescent elastin structures within the alveoli. With it, multiple changes in the elastin structure due to different diffuse parenchymal lung diseases have previously been described. However, these evaluations have mainly relied on qualitative evaluation by the examiner and manually selected parts post-examination. OBJECTIVES:To develop a fully automatic method for quantifying structural properties of the imaged alveoli elastin and to perform a preliminary assessment of their diagnostic potential. METHODS:46 patients underwent probe-based confocal endomicroscopy, of which 38 were divided into 4 groups categorizing different diffuse parenchymal lung diseases. 8 patients were imaged in representative healthy lung areas and used as control group. Alveolar elastin structures were automatically segmented with a trained machine learning algorithm and subsequently evaluated with two methods developed for quantifying the local thickness and structural connectivity. MEASUREMENTS AND MAIN RESULTS:The automatic segmentation algorithm performed generally well and all 4 patient groups showed statistically significant differences with median elastin thickness, standard deviation of thickness and connectivity compared to the control group. CONCLUSION:Alveoli elastin structures can be quantified based on their structural connectivity and thickness statistics with a fully-automated algorithm and initial results highlight its potential for distinguishing parenchymal lung diseases from normal alveoli.
| S-EPMC7202624 | biostudies-literature
Project description:BackgroundWhite-light endoscopy and microscopy combined with histological analysis is currently the mainstay for intraprocedural tissue diagnosis during panendoscopy for head and neck cancer. However, taking biopsies leads to selection bias, ex vivo histopathology is time-consuming, and the advantages of in-vivo intraoperative decision making cannot be used. Confocal laser endomicroscopy (CLE) has the potential for a rapid and histological assessment in the head and neck operating room.MethodsBetween July 2019 and January 2020, 13 patients (69% male, median age: 61 years) with newly diagnosed head and neck cancer (T3/T4: 46%) underwent fluorescein-guided panendoscopy. CLE was performed from both the tumor and margins followed by biopsies from the CLE spots. The biopsies were processed for histopathology. The CLE images were ex vivo classified blinded with a CLE cancer score (DOC score). The classification was compared to the histopathological results.ResultsMedian additional time for CLE during surgery was 9 min. A total of 2,565 CLE images were taken (median CLE images: 178 per patient; 68 per biopsy; evaluable 87.5%). The concordance between histopathology and CLE images varied between the patients from 82.5 to 98.6%. The sensitivity, specificity, and accuracy to detect cancer using the classified CLE images was 87.5, 80.0, and 84.6%, respectively. The positive and negative predictive values were 87.0 and 80.0%, respectively.ConclusionCLE with a rigid handheld probe is easy and intuitive to handle during panendoscopy. As next step, the high accuracy of ex vivo CLE image classification for tumor tissue suggests the validation of CLE in vivo. This will evolve CLE as a complementary tool for in vivo intraoperative diagnosis during panendoscopy.
| S-EPMC8236705 | biostudies-literature
Project description:AimTo evaluate the diagnostic potential of Lugol's chromoendoscopy-guided confocal laser endomicroscopy (CLE) in detecting superficial esophageal squamous cell neoplasia (ESCN).MethodsBetween December 2008 and September 2010, a total of 52 patients were enrolled at the Chinese PLA General Hospital in Beijing, China. First, Lugol's chromoendoscopy-guided CLE was performed in these patients and the CLE in vivo histological diagnosis was recorded. Then, chromoendoscopy-guided biopsy was performed in the same patients by another endoscopist who was blinded to the CLE findings. Based on the biopsy and CLE diagnosis, en bloc endoscopic resection was performed. The CLE in vivo diagnosis and the histological diagnosis of biopsy of ESCN were compared, using a histological examination of the endoscopic resection specimens as the standard reference.ResultsA total of 152 chromoendoscopy-guided biopsies were obtained from 56 lesions. In the 56 lesions of 52 patients, a total of 679 CLE images were obtained vs 152 corresponding biopsies. The sensitivity, specificity, negative predictive value and positive predictive value of chromoendoscopy-guided CLE compared with biopsy were 95.7% vs 82% (P < 0.05), 90% vs 70% (P < 0.05), 81.8% vs 46.7% (P < 0.05), and 97.8% vs 92.7% (P > 0.05), respectively. There was a significant improvement in sensitivity, specificity, negative predictive value, and accuracy when comparing chromoendoscopy-guided CLE with biopsy.ConclusionLugol's chromoendoscopy-guided CLE is a real-time, non-invasive endoscopic diagnostic technology; the accuracy of the detection of superficial ESCN is equivalent to or may be superior to biopsy histology.
| S-EPMC4462739 | biostudies-literature
Project description:PurposeProfound changes of the vasculature in tumors critically impact drug delivery and therapy response. We aimed at developing a procedure to monitor morphological and functional parameters of the vasculature in subcutaneous xenograft models commonly applied for therapy testing by using probe-based confocal laser endomicroscopy.ProceduresBy monitoring various normal and diseased tissues, we established an experimental and analytical set-up to systematically analyze tracer extravasation from the microvasculature. Application of the approach in two xenograft models (HCT-116 and SW620) was realized consecutively throughout tumor growth.ResultsThe incidence of dilated vessels increased with xenograft size in both models while macromolecule extravasation and tracer accumulation in the tumor tissue, respectively, was significantly reduced throughout growth. The development of dilated/ultradilated vessels correlated with tracer extravasation only in the HCT-116 but not the SW620 model. The underlying mechanisms are still ambiguous and discussed.ConclusionsOur findings clearly indicate that both xenograft type and size matter for drug delivery and therapy testing.
| S-EPMC3826054 | biostudies-literature
Project description:The aim of the present study was to propose a new pCLE classification of gastric pit patterns and vessel architecture, and to assess the accuracy and interobserver agreement of this new pCLE classification system in the stomach.
| 2148078 | ecrin-mdr-crc
Project description:Background and study aims:?Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is a keystone in diagnosing and staging of pancreatic masses. Recently, a microfiber that can pass through a 19-gauge needle has been introduced for confocal laser endomicroscopy (nCLE). The aims of this study were to evaluate the diagnostic value and the reproducibility of nCLE criteria for solid malignant lesions. Patients and methods:?This prospective dual-center study included patients with pancreatic masses suspicious of malignancy referred for EUS-FNA. Endomicroscopic imaging was performed under EUS-guidance until organ-specific structures were obtained. Afterwards, standard cytology was obtained and patients were followed for up to 12 months. All nCLE parameters included in former studies were correlated with the final diagnosis (dark lobular structures/normal acinar cells, dark cell aggregates?>?40?µm, dilated irregular vessels with fluorescein leakage, fine white fibrous bands, small black cell movements, pseudoglandular structures). Finally, three CLE novices and three CLE experts assessed the unedited movies from all patients. Results:?Twenty-eight patients were enrolled in the study. A final diagnosis was obtained in 24 patients (86?%). One patient (3?%) died before a diagnosis was obtained, while 3 were lost to follow-up (11?%). In 18/24 patients (74?%) the diagnosis was malignant. The mean sensitivity, specificity, and accuracy for the nCLE parameters ranged from 19?-?93 %, 0?-?56?%, 26?-?69?%, respectively. The inter-observer values ranged from ??=?0.20?-?0.41 for novices and ??=?-0.02?-?0.38 for experts. Conclusions:?The diagnostic value of nCLE in solid pancreatic masses is questionable and the inter-observer agreement for both novices and CLE experts appears limited.
| S-EPMC5770262 | biostudies-literature
Project description:Probe-based confocal laser endomicroscopy (pCLE) allows for real-time diagnosis of dysplasia and cancer in Barrett's esophagus (BE) but is limited by low sensitivity. Even the gold standard of histopathology is hindered by poor agreement between pathologists. We deployed deep-learning-based image and video analysis in order to improve diagnostic accuracy of pCLE videos and biopsy images. Blinded experts categorized biopsies and pCLE videos as squamous, non-dysplastic BE, or dysplasia/cancer, and deep learning models were trained to classify the data into these three categories. Biopsy classification was conducted using two distinct approaches-a patch-level model and a whole-slide-image-level model. Gradient-weighted class activation maps (Grad-CAMs) were extracted from pCLE and biopsy models in order to determine tissue structures deemed relevant by the models. 1970 pCLE videos, 897,931 biopsy patches, and 387 whole-slide images were used to train, test, and validate the models. In pCLE analysis, models achieved a high sensitivity for dysplasia (71%) and an overall accuracy of 90% for all classes. For biopsies at the patch level, the model achieved a sensitivity of 72% for dysplasia and an overall accuracy of 90%. The whole-slide-image-level model achieved a sensitivity of 90% for dysplasia and 94% overall accuracy. Grad-CAMs for all models showed activation in medically relevant tissue regions. Our deep learning models achieved high diagnostic accuracy for both pCLE-based and histopathologic diagnosis of esophageal dysplasia and its precursors, similar to human accuracy in prior studies. These machine learning approaches may improve accuracy and efficiency of current screening protocols.
| S-EPMC7930108 | biostudies-literature