Ellebrecht David B, Gebhard Maximilian P E, Horn Marco, Keck Tobias, Kleemann Markus
University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
Surg Innov. 2016 Aug;23(4):341-6. doi: 10.1177/1553350616637690. Epub 2016 Mar 13.
Introduction Histological analysis of surgical specimen is the gold standard for cancer classification. In particular, frozen histological diagnosis of vague peritoneal spots or uncertain excision of tumors plays a crucial role for proceeding with or without change of the operation procedure. Confocal laser microscopy (CLM) enables in vivo and real-time high-resolution tissue analysis. To evaluate a novel technique of CLM without any fluorescent dye, this pilot ex vivo study demonstrates a CLM camera device for minimal invasive surgical approach. Methods In 5 cases, a laparoscopic CLM camera was used for examining colon and rectum specimen. Images of nonmalignant and malignant intestinal mucosa were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described. Results Using this CLM camera device, it is possible to analyze colon specimen mucosa. Nonmalignant and malignant intestinal mucosa show specific signal patterns. Nonmalignant mucosa is defined by honeycomb structure. There is deregulated structure in colon and rectum carcinoma mucosa. The inside lumen is irregular. The radial border appears swollen with reduced contrast. Discussion This pilot study shows that the assessment of colon mucosa with a prototype of CLM camera for minimally invasive surgical approach without any fluorescent dye is feasible. It is possible to differentiate between benign and malignant mucosa in colon specimen by easy to evaluate and reproducible parameters. These first steps of this pioneering achievement to establish CLM in minimal invasive surgical procedures show a great potential for a more reliable intraoperative evaluation of suspect foci.
引言 手术标本的组织学分析是癌症分类的金标准。特别是，对模糊的腹膜斑点进行冷冻组织学诊断或对肿瘤进行不确定的切除，对于决定是否改变手术程序起着至关重要的作用。共聚焦激光显微镜（CLM）能够进行体内实时高分辨率组织分析。为了评估一种无需任何荧光染料的CLM新技术，这项初步的离体研究展示了一种用于微创外科手术的CLM摄像设备。方法 对5例患者，使用腹腔镜CLM摄像头检查结肠和直肠标本。根据特定信号模式对非恶性和恶性肠黏膜图像进行特征描述。未使用荧光染料。系统记录并描述与传统组织学检查结果的相关性。结果 使用这种CLM摄像设备，可以分析结肠标本黏膜。非恶性和恶性肠黏膜呈现出特定信号模式。非恶性黏膜由蜂窝状结构定义。结肠和直肠癌黏膜结构紊乱。肠腔内不规则。径向边界显得肿胀，对比度降低。讨论 这项初步研究表明，使用CLM摄像头原型对结肠黏膜进行微创外科手术评估且不使用任何荧光染料是可行的。通过易于评估且可重复的参数，可以区分结肠标本中的良性和恶性黏膜。在微创外科手术中建立CLM的这一开创性成果的这些初步步骤，显示出对可疑病灶进行更可靠术中评估的巨大潜力。
