Xiaoling Zheng1, Ning Zuo2, Hongxin Lin2, Liqin Zheng2, Ming Ni3, Guizhu Wu4, Jianxin Chen2, Shuangmu Zhuo5,6. 1. Department of Endoscopy, Fujian Provincal Hospital, Fujian Medical University & College of Photonic and Electronic Engineering, Fujian Normal University, Fuzhou, China. 2. 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. 3. School of Biological Sciences & Engineering, Yachay Tech University, Hacienda San José s/n, 100105, San Miguel de Urcuquí, Ecuador. 4. Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. wugz6666@126.com. 5. Department of Endoscopy, Fujian Provincal Hospital, Fujian Medical University & College of Photonic and Electronic Engineering, Fujian Normal University, Fuzhou, China. shuangmuzhuo@gmail.com. 6. 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. shuangmuzhuo@gmail.com.
Abstract
BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: These results indicate that MPM can be used as an effective, real-time, and label-free novel method to determine intraoperative resection margins.
BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: These results indicate that MPM can be used as an effective, real-time, and label-free novel method to determine intraoperative resection margins.
Entities:
Keywords:
ESD; Early gastric cancer; Multiphoton microscopy; Resection margin
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