Minimal invasive confocal laser microscopy for tissue and resection margin analysis: a pilot ex-vivo study in lung cancer

Hintergrund:

Histological analysis of surgical specimen is the gold standard for cancer classification. In particular, frozen histological diagnosis of vague peritoneal spots or uncertain excision of tumours plays a crucial role for proceeding with or without change of the operation procedure. Confocal laser microscopy (CLM) enables in-vivo and real-time high-resolution tissue analysis. To evaluate a novel technique of CLM without any fluorescent dye, this pilot ex-vivo study demonstrates a CLM camera device for minimal invasive thoracic surgical approach.

Material und Methode:

In 5 cases a minimal-invasive CLM camera was used for examining lung specimen. Images of non-malignant and malignant lung areas were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described.

Ergebnis:

Using this CLM camera device, it is possible to analyze lung specimen. Nonmalignant and malignant lung areas show specific signal-patterns. Non-malignant lung tissue is defined by a 3D structure of alveoli structure. There is deregulated structure in lung carcinoma tissue. 3D pattern of alveoli is eliminated. The alveoli lumen is irregular and washed-out, non-rotund and with a diffuse edge. Comparing to non-malignant lung tissue there were more artefacts (e.g. detritus).

Schlussfolgerung:

This pilot study shows that the assessment of lung tissue with a prototype of CLM camera for minimal-invasive surgical approach without any fluorescent dye is feasible. It is possible to differentiate between benign and malignant areas in lung specimen by easy to evaluate and reproducible parameters. These first steps of this pioneering achievement to establish CLM in minimal invasive surgical procedures show a great potential for a more reliable intraoperative evaluation of suspect foci.