Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo

Kießlich, Ralf; Burg, Juergen; Vieth, Michael; Gnaendiger, Janina; Enders, Meike; Delaney, Peter; Polglase, A. L.; McLaren, Wendy J; Janell, Daniela; Thomas, Steven; Nafe, B.; Galle, Peter R.; Neurath, Markus F.

doi:10.1053/j.gastro.2004.06.050

Cited by 774 publications

(667 citation statements)

References 31 publications

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“…The advantages of the cathepsin-activatable NIRF probe were also observed in our study, when the molecular probe was compared with the nonspecific vascular contrast agent fluorescein, which has already been used for the detection of neoplastic precursor lesions and cancer in the gastrointestinal tract in humans (26)(27)(28). Morphological changes such as fibrosis, which are associated with pancreatic neoplasia, precluded the distinct detection and evaluation of mPanIN lesions and early-stage PDAC by CFL using fluorescein.…”

Section: Discussionsupporting

confidence: 60%

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

Eser

Messer²,

Eser³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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Pancreatic ductal adenocarcinoma (PDAC) is a fatal disease with poor patient outcome often resulting from late diagnosis in advanced stages. To date methods to diagnose early-stage PDAC are limited and in vivo detection of pancreatic intraepithelial neoplasia (PanIN), a preinvasive precursor of PDAC, is impossible. Using a cathepsin-activatable near-infrared probe in combination with flexible confocal fluorescence lasermicroscopy (CFL) in a genetically defined mouse model of PDAC we were able to detect and grade murine PanIN lesions in real time in vivo. Our diagnostic approach is highly sensitive and specific and proved superior to clinically established fluorescein-enhanced imaging. Translation of this endoscopic technique into the clinic should tremendously improve detection of pancreatic neoplasia, thus reforming management of patients at risk for PDAC. is one of the deadliest human malignancies, with an extremely poor 5-y survival rate below 5% (1). Because patients generally present with symptoms relating to late stages of the disease, diagnosis of resectable PDAC is achieved in less than 15% of cases (1). However, investigators have reported that diagnosis and resection of early-stage PDAC (<2 cm in size) can result in a 4-y survival rate of up to 78% (2-5). These data suggest that early detection of PDAC can improve patient outcome. In addition, it has been shown that resection of PDAC combined with adjuvant chemotherapy can improve 5-y survival rates to 25%. Thus, increasing the chance of resection will lead to improved survival.Of the more than 33,000 new cases of PDAC diagnosed in the United States every year, ∼10% occur in families with a high prevalence of PDAC and are thus referred to as familial (6, 7). In a cohort study of twins, it was proposed that inherited factors may be responsible for up to 36% of pancreatic cancers, suggesting that the incidence of familial pancreatic cancer may be even higher than presently assumed (8). To date, several conditions associated with familial PDAC have been described and groups of individuals at low, moderate, or high risk for developing the disease have been defined (9, 10). Although clinical trials are currently testing screening protocols for the high-risk group, aimed at detecting curable precursors of PDAC such as intraductal papillary mucinous neoplasia, pancreatic intraepithelial neoplasia (PanIN), and early-stage PDAC (10-12), the results of these trials show that early lesions are often missed. Furthermore, false positive findings can lead to overtreatment of a significant fraction of the screened population (12). These findings show that better diagnostic tools for the detection of preneoplastic lesions and early-stage PDAC are urgently needed. Recent data demonstrate that preinvasive precursors progress slowly over many years to decades to invasive pancreatic cancer (13). The parental pancreatic cancer founder clone then requires more than 5 y to acquire the capacity to metastasize (13). Thus, there is a time frame of several years for the diagnosi...

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Section: Discussionsupporting

confidence: 60%

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

Eser

Messer²,

Eser³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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“…Die konfokale Lasermikroskopie bleibt derzeit noch wissenschaftlichen Fragestellungen vorbehalten [497]. Bei größeren flachen Adenomen (sog.…”

Section: Level Of Evidence 1bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

132

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“…One such example of its utility includes a study from Kiesslich et al 36 demonstrating diagnostic accuracy of 99.2% in detecting neoplastic mucosa of the colon. 36,37 However, the more common clinical application of CLE lies in pancreatobiliary disease. This is largely due to pCLE's size, which allows it to be passed through the EUS-FNA needle system with the CholangioFlex confocal probe (Mauna Kea Technologies) and access the bile and pancreatic ducts.…”

Section: Confocal Laser Endomicroscopymentioning

confidence: 99%

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

Luthra

Mishra

2017

Int J Gastrointest Interv

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Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo

Cited by 774 publications

References 31 publications

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

S3-Leitlinie – Kolorektales Karzinom

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

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