Department of Thoracic Surgery, LungClinic Großhansdorf, Wöhrendamm 80, 22927 Großhansdorf, Germany.
Biomed Tech (Berl). 2021 Dec 17;67(1):11-17. doi: 10.1515/bmt-2021-0171. Print 2022 Feb 23.
Surgeons lose most of their tactile tissue information during minimal invasive surgery and need an additional tool of intraoperative tissue recognition. Confocal laser microscopy (CLM) is a well-established method of tissue investigation. The objective of this study was to analyze the feasibility and diagnostic accuracy of CLM nervous tissue recognition. Images taken with an endoscopic CLM system of sympathetic ganglions, nerve fibers and pleural tissue were characterized in terms of specific signal-patterns ex-vivo. No fluorescent dye was used. Diagnostic accuracy of tissue classification was evaluated by newly trained observers (sensitivity, specificity, PPV, NPV and interobserver variability). Although CLM images showed low CLM image contrast, assessment of nerve tissue was feasible without any fluorescent dye. Sensitivity and specificity ranged between 0.73 and 0.9 and 0.55-1.0, respectively. PPVs were 0.71-1.0 and the NPV range was between 0.58 and 0.86. The overall interobserver variability was 0.36. The eCLM enables to evaluate nervous tissue and to distinguish between nerve fibers, ganglions and pleural tissue based on backscattered light. However, the low image contrast and the heterogeneity in correct tissue diagnosis and a fair interobserver variability indicate the limit of CLM imaging without any fluorescent dye.
外科医生在微创手术中失去了大部分触觉组织信息，因此需要一种额外的术中组织识别工具。共焦激光显微镜（CLM）是一种成熟的组织研究方法。本研究的目的是分析 CLM 神经组织识别的可行性和诊断准确性。使用内窥镜 CLM 系统对交感神经节、神经纤维和胸膜组织进行拍摄，对离体组织的特定信号模式进行特征描述。未使用荧光染料。通过新培训的观察者（敏感性、特异性、PPV、NPV 和观察者间变异性）评估组织分类的诊断准确性。尽管 CLM 图像的对比度较低，但无需任何荧光染料即可评估神经组织。神经组织的敏感性和特异性分别在 0.73 到 0.9 和 0.55 到 1.0 之间。PPV 为 0.71 到 1.0，NPV 范围在 0.58 到 0.86 之间。总体观察者间变异性为 0.36。eCLM 能够评估神经组织，并根据背向散射光区分神经纤维、神经节和胸膜组织。然而，低图像对比度和正确组织诊断的异质性以及观察者间的适度变异性表明，在没有任何荧光染料的情况下，CLM 成像存在局限性。
