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

Sawada, Toru; Takizawa, Hiromitsu; Aoyama, Mariko; Kawakita, Naoya; Miyamoto, Naoki; Sakamoto, Shinichi; Takashima, Mika; Matsumoto, Daisuke; Toba, Hiroaki; Kawakami, Yukikiyo; Yoshida, Misao; Kondo, Kazuya; Tangoku, Akira

doi:10.21037/jtd-21-137

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…Xie et al ( 14 ) reported that the accuracy, sensitivity, and specificity of intraoperative autofluorescence staining of frozen sections in the diagnosis of VPI of lung adenocarcinoma ≤2 cm were 95.5%, 86.8%, and 100%, respectively. Sawada et al ( 18 ) calculated that the diagnosis accuracy of confocal laser endomicroscopy was as high as 86.7%. These findings are conducive to the decision-making of surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…VPI is graded as PL1 and PL2, and it is recommended that EFs staining should be evaluated when hematoxylin-eosin (HE) staining does not clearly distinguish PL0 from PL1 ( 6 ). Several studies have regarded the significance of accurate prediction and diagnosis of VPI for treatment decisions of lung cancer patients in the preoperative and intraoperative stages ( 7 - 18 ). Therefore, this review summarizes the recent research in predicting VPI.…”

Section: Introductionmentioning

confidence: 99%

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Research progress in predicting visceral pleural invasion of lung cancer: a narrative review

Wang,

Lyu,

Fan

et al. 2024

Transl Cancer Res

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Background and Objective In lung cancer, visceral pleural invasion (VPI) affects the selection of surgical methods, the scope of lymph node dissection and the need for adjuvant chemotherapy. Preoperative or intraoperative prediction and diagnosis of VPI of lung cancer is helpful for choosing the best treatment plan and improving the prognosis of patients. This review aims to summarize the research progress of the clinical significance of VPI assessment, the intraoperative diagnosis technology of VPI, and various imaging methods for preoperative prediction of VPI. The diagnostic efficacy, advantages and disadvantages of various methods were summarized. The challenges and prospects for future research will also be discussed. Methods A comprehensive, non-systematic review of the latest literature was carried out in order to investigate the progress of predicting VPI. PubMed database was being examined and the last run was on 4 August 2022. Key Content and Findings The pathological diagnosis and clinical significance of VPI of lung cancer were discussed in this review. The research progress of prediction and diagnosis of VPI in recent years was summarized. The results showed that preoperative imaging examination and intraoperative freezing pathology were of great value. Conclusions VPI is one of the adverse prognostic factors in patients with lung cancer. Accurate prediction of VPI status before surgery can provide guidance and help for the selection of clinical operation and postoperative treatment. There are some advantages and limitations in predicting VPI based on traditional computed tomography (CT) signs, 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) techniques. As an emerging technology, radiomics and deep learning show great potential and represent the future research direction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Research progress in predicting visceral pleural invasion of lung cancer: a narrative review

Wang,

Lyu,

Fan

et al. 2024

Transl Cancer Res

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“…In malignant pleural effusion, a pilot study demonstrated that pCLE was capable of detecting malignant cells of pleural effusion rapidly and simply [46]. Moreover, SAWADA et al [47] investigated the feasibility of intraoperative detection of visceral pleural invasion (VPI) using pCLE imaging in patients with primary lung cancer. They demonstrated that the accuracy rate in the diagnosis of VPI through pCLE was 86.7%.…”

Section: Pleuramentioning

confidence: 99%

“…Moreover, S awada et al . [ 47 ] investigated the feasibility of intraoperative detection of visceral pleural invasion (VPI) using pCLE imaging in patients with primary lung cancer. They demonstrated that the accuracy rate in the diagnosis of VPI through pCLE was 86.7%.…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…Lung cancer Identification of malignant lymph nodes [42,43] Distinguish malignant from benign reactive lymph nodes Pleura Pleural lesions Discrimination of normal and abnormal pleura [44,45] Detection of malignant cells in pleural effusion [46] Detection of VPI [47] Pleural lesions Discrimination of MPM and pleural fibrosis [45] Biopsy guidance Improve cytological-aided diagnosis of malignant effusions Determine surgical procedures…”

Section: Introductionmentioning

confidence: 99%

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The role of confocal laser endomicroscopy in pulmonary medicine

Tian¹,

Huang²,

Zhang

et al. 2023

Eur Respir Rev

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Accurate diagnosis and subsequent therapeutic options in pulmonary diseases mainly rely on imaging methods and histological assessment. However, imaging examinations are hampered by the limited spatial resolution of images and most procedures that are related to histological assessment are invasive with associated complications. As a result, a high-resolution imaging technology – confocal laser endomicroscopy (CLE), which is at the forefront and enables real-time microscopic visualisation of the morphologies and architectures of tissues or cells – has been developed to resolve the clinical dilemma pertaining to current techniques. The current evidence has shown that CLE has the potential to facilitate advanced diagnostic capabilities, to monitor and to aid the tailored treatment regime for patients with pulmonary diseases, as well as to expand the horizon for unravelling the mechanism and therapeutic targets of pulmonary diseases. In the future, if CLE can be combined with artificial intelligence, early, rapid and accurate diagnosis will be achieved through identifying the images automatically. As promising as this technique may be, further investigations are required before it can enter routine clinical practice.

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Advances in early detection of non‐small cell lung cancer: A comprehensive review

Kenaan,

Hanna,

Sardini

et al. 2024

Cancer Medicine

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BackgroundLung cancer has the highest mortality rate among malignancies globally. In addition, due to the growing number of smokers there is considerable concern over its growth. Early detection is an essential step towards reducing complications in this regard and helps to ensure the most effective treatment, reduce health care costs, and increase survival rates.AimsTo define the most efficient and cost‐effective method of early detection in clinical practice.Materials and MethodsWe collected the Information used to write this review by searching papers through PUBMED that were published from 2021 to 2024, mainly systematic reviews, meta‐analyses and clinical‐trials. We also included other older but notable papers that we found essential and valuable for understanding.ResultsEB‐OCT has a varied sensitivity and specificity—an average of 94.3% and 89.9 for each. On the other hand, detecting biomarkers via liquid biopsy carries an average sensitivity of 91.4% for RNA molecules detection, and 97% for combined methylated DNA panels. Moreover, CTCs detection did not prove to have a significant role as a screening method due to the rarity of CTCs in the bloodstream thus the need for more blood samples and for enrichment techniques.DiscussionAlthough low‐dose CT scan (LDCT) is the current golden standard screening procedure, it is accompanied by a highly false positive rate. In comparison to other radiological screening methods, Endobronchial optical coherence tomography (EB‐OCT) has shown a noticeable advantage with a significant degree of accuracy in distinguishing between subtypes of non‐small cell lung cancer. Moreover, numerous biomarkers, including RNA molecules, circulating tumor cells, CTCs, and methylated DNA, have been studied in the literature. Many of these biomarkers have a specific high sensitivity and specificity, making them potential candidates for future early detection approaches.ConclusionLDCT is still the golden standard and the only recommended screening procedure for its high sensitivity and specificity and proven cost‐effectiveness. Nevertheless, the notable false positive results acquired during the LDCT examination caused a presumed concern, which drives researchers to investigate better screening procedures and approaches, particularly with the rise of the AI era or by combining two methods in a well‐studied screening program like LDCT and liquid biopsy. we suggest conducting more clinical studies on larger populations with a clear demographical target and adopting approaches for combining one of these new methods with LDCT to decrease false‐positive cases in early detection.

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

Cited by 6 publications

References 24 publications

Research progress in predicting visceral pleural invasion of lung cancer: a narrative review

Research progress in predicting visceral pleural invasion of lung cancer: a narrative review

The role of confocal laser endomicroscopy in pulmonary medicine

Advances in early detection of non‐small cell lung cancer: A comprehensive review

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