Department of Endoscopy, Fujian Provincal Hospital, Fujian Medical University & College of Photonic and Electronic Engineering, Fujian Normal University, Fuzhou, China.
Fujian Provincial Key Laboratory for Photonics Technology & Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, China.
Surg Endosc. 2020 Jan;34(1):408-416. doi: 10.1007/s00464-019-06783-1. Epub 2019 Apr 10.
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.
内镜黏膜下剥离术（ESD）已成为治疗早期胃癌（EGC）的主要选择。因此，有必要诊断 ESD 标本边缘是否存在残留癌细胞，这将影响未来肿瘤的复发和生存率。多光子显微镜（MPM）可适用于对细胞水平的生物组织进行非破坏性成像，从而实现内镜治疗过程中的实时指导。有鉴于此，本研究旨在探讨 MPM 在 EGC 情况下用于诊断 ESD 标本边缘的实用性。
首先，使用提出的 MPM 技术对总共 20 个手术样本进行成像，以获得来自细胞内固有荧光物质的双光子激发荧光信号和来自胶原蛋白的二次谐波产生信号；这些信号用于确定 MPM 病理特征以进行边缘诊断。然后，对 50 个样本进行了一项双盲研究，以根据获得的 MPM 病理特征评估诊断结果。
多光子显微镜能够准确识别负边缘和正边缘组织之间的细胞学和形态学差异。MPM 诊断 ESD 标本边缘的灵敏度、特异性、准确性、阴性预测值和阳性预测值分别为 97.62%、75.00%、94.00%、95.35%和 85.71%。
这些结果表明，MPM 可作为一种有效、实时且无需标记的新型方法，用于确定术中切除边缘。
