Confocal laser endomicroscopy in breast surgery: a pilot study

Abstract

BackgroundBreast neoplasms include different histopathological entities, varying from benign tumors to highly aggressive cancers. Despite the key role of imaging, traditional histology is still required for a definitive diagnosis. Confocal Laser Endomicroscopy (CLE) is a new technique, which enables to obtain histopathological images in vivo, currently used in the diagnosis of gastrointestinal diseases. This is a single-center pilot feasibility study; the main aim is to describe the basic morphological patterns of Confocal Laser Endomicroscopy in normal breast tissue besides benign and malignant lesions.MethodsThirteen female patients (mean age 52.7, range from 22 to 86) who underwent surgical resection for a palpable breast nodule were enrolled. CLE was performed soon after resection with the Cellvizio® Endomicroscopy System (Mauna Kea Technologies, Paris, France), by using a Coloflex UHD-type probe; intravenous fluorescein was used as contrast-enhancing agent. The surgical specimen was cut along the main axis; dynamic images were obtained and recorded using a hand-held probe directly applied both to the internal part of the lesion and to several areas of surrounding normal tissue. Each specimen was then sent for definitive histologic examination.ResultsHistopathology revealed a benign lesion in six patients (46%), while a breast cancer was diagnosed in seven women (54%). Confocal laser endomicroscopy showed some peculiar morphological patterns. Normal breast tissue was characterized by a honeycomb appearance with regular, dark, round or hexagonal glandular lobules on a bright stroma background; tubular structures, representing ducts or blood vessels, were also visible in some frames. Benign lesions were characterized by a well-demarcated “slit-like” structure or by lobular structures in abundant bright stroma. Finally, breast cancer was characterized by a complete architectural subversion: ductal carcinoma was characterized by ill-defined structures, with dark borders and irregular ductal shape, formingribbons, tubules or nests; mucinous carcinoma showed smaller cells organized in clusters, floating in an amorphous extracellular matrix.ConclusionsThis is the first pilot study to investigate the potential role of confocal laser imaging as a diagnostic tool in breast diseases. Further studies are required to validate these results and establish the clinical impact of this technique.

Confocal laser endomicroscopy in breast surgery

“…We found that a longer interval (with fluorescein infusion at least 5 min before surgical resection) provides a better fluorescein impregnation with consequent better quality images. This was particularly true in benign lesions, probably due to the hypovascularization of such lesions; we also argued how the relation between the fluorescein infusion interval and image quality might also be considered as a further criteria to discriminate between benign and malignant lesions [2].…”

“…We strongly believe in the diagnostic potential of confocal laser endomicroscopy in surgical oncology and we would also like to note that our research group has actually already published preliminary data on the role of p-CLE in breast imaging [2]. In our original article entitled ''Confocal laser endomicroscopy in breast surgery: a pilot study'', published back in April 2015, we similarly describe morphological patterns at p-CLE of both breast cancer and normal tissue; moreover, we have also performed the confocal imaging on patients affected by benign breast diseases (e.g.…”

Identification of liver metastases with probe‐based confocal laser endomicroscopy at two excitation wavelengths

“…Depending on the tissue type, diagnostic accuracy is in the range of 86-91% [24][25][26][27]. Recent reports suggest that pCLE may also be a useful tool for the detection of breast and head and neck cancers [28,29].…”

Methylene-blue aided rapid confocal laser endomicroscopy of breast cancer

“…To avoid these safety concerns, a subsequent in-vivo human study used intravenous fluorescein as the contrast agent, a compound that is well-established as being safe for in-vivo human use 12 and is commonly employed for other clinical applications of pCLE. 13,14 However, since fluorescein staining is nonspecific, it does not highlight tissue morphology as effectively, causing difficulties in distinguishing between benign and malignant lesions.…”

“…13,14 However, since fluorescein staining is nonspecific, it does not highlight tissue morphology as effectively, causing difficulties in distinguishing between benign and malignant lesions. 12 For intraoperative margin assessment in routine clinical practice, it is desirable to use endomicroscopes with approved fluorescent dyes, which are both safe for in-vivo human use and provide sufficient contrast to discriminate between different tissue morphologies. In this letter, we demonstrate that normal and cancerous breast tissue stained with methylene-blue, and excited at 660 nm, exhibits comparable morphological features to acriflavine-stained tissue.…”