Work

An in vivo pilot study of probe-based confocal laser endomicroscopy for detecting of pancreatic ductal adenocarcinoma intraoperatively

Year: 2025

Type: article

Abstract: BACKGROUND: As a noninvasive and real-time imaging technique, probe-based confocal laser endomicroscopy (PCLE) has been widely used to detect malignancies and guide a biopsy. However, no studies have reported the use of PCLE to identify pancreatic ductal adenocarcinoma (PDAC) intraoperatively. MATERIALS AND METHODS: Patients, who were diagnosed with suspicious PDAC and recommended for surgery, were included in this study. Intraoperatively, PCLE was used to scan the surface of the targeted lesions for acquiring in-vivo images. Then, surgeons took imaging-site samples for histopathological examinations. Two pathologists reviewed all PCLE videos and selected clear and representative images by comparing them with imaging-site pathological images. Finally, Image pro plus 6.0 was used to measure 11 morphological parameters of selected images, and SPSS 25.0 was used to examine the morphological difference between different tissues. RESULTS: A total of 13 patients were enrolled, and 9 cases were pathologically proven with PDAC. 79 zones were imaged through PCLE and 92 representative images were selected, including images of normal glandular tissue, PDAC images, adipose cells images, negative arterial margin images, and serous cystadenoma (SCA) images. Normal glandular cells showed a close arrangement of cells resembling coffee beans, which had clear boundaries. PDAC cells appeared as oval cells of varying sizes, often surrounded by thick tumor fibers. Compared with glandular cells, tumor cells and tumor fibers had high significance in several morphological parameters such as diameter, perimeter, area, density and roundness (P < 0.05). Then we exhibited images of periarterial adipose cells and SCA. CONCLUSION: PCLE is an effective tool for accurate and real-time intraoperative detection of PDAC, and it has the potential to assist surgeons in determining the extent of resection. This study reported representative in-vivo PCLE images of PDAC, and more studies are needed for evaluating the diagnostic performance of the PCLE in operations.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000003754