Diagnosis of visceral pleural invasion using confocal laser endomicroscopy during lung cancer surgery

Journal of Thoracic Disease

article

Toru Sawada¹  Hiromitsu Takizawa¹  Mariko Aoyama¹  Naoya Kawakita¹  Naoki Miyamoto¹  Shinichi Sakamoto¹  Mika Takashima¹  Daisuke Matsumoto¹  Hiroaki Toba¹  Yukikiyo Kawakami¹  Mitsuteru Yoshida¹  Kazuya Kondo²  Akira Tangoku¹ 

[1] Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Graduate School of Biomedical Sciences;Department of Oncological Medical Services, Tokushima University Graduate School of Biomedical Sciences

关键词: Lung cancer;    visceral pleural invasion (VPI);    confocal laser endomicroscopy (CLE);   

DOI  :  10.21037/jtd-21-137

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Visceral pleural invasion (VPI) in lung cancer is a significant prognostic factor; however, it is difficult to diagnose preoperatively or intraoperatively. In this study, we examined the possibility of intraoperative diagnosis of VPI using confocal laser endomicroscopy (CLE). Methods: Among patients with primary lung cancer who underwent surgery between April 2018 and August 2019, those in whom the tumor was in contact with the pleura on chest computed tomography and whose pleural changes were intraoperatively confirmed were enrolled in this study. In the 35 patients who underwent lung resection (6 cases with visceral pleural infiltration), the area where pleural change was noted was observed and a short video was recorded using CLE. Based on the video images, three evaluators determined the defect ratio (0%, 25%, 50%, 75%, and 100%) of the autofluorescence-positive structure. The area under the receiver operating characteristic curve was used to evaluate the diagnostic performance for VPI. In 15 cases (3 cases with VPI), a validation study was performed for intraoperative VPI according to the cutoff value of the defect ratio of the autofluorescence-positive structure. Results: The areas under the receiver operating characteristic curve for the defect ratio of the autofluorescence-positive structure were 0.86–0.91 for the three readers. Using defect ratio of autofluorescence-positive structure cutoff of ≥50% as predictor of VPI, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 83.3–100.0%, 57.7–73.1%, 35.3–41.7%, 95.0–100.0%, and 75.0–78.1%, respectively, for the three readers. In the validation study, the sensitivity was 100%, the specificity was 83.3%, and the diagnostic accuracy rate was 86.7%. Conclusions: The diagnosis of VPI through CLE is simple, non-invasive, and has high diagnostic accuracy rates. This method may be applicable for determining surgical procedures.

【 授权许可】

Unknown