Fluorescent Tissue Assessment of Colorectal Cancer Liver Metastases Ablation Zone: A Potential Real-Time Biomarker of Complete Tumor Ablation
Fluorescent Tissue Assessment of Colorectal Cancer Liver Metastases Ablation Zone: A Potential Real-Time Biomarker of Complete Tumor Ablation
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DOI：
10.1245/s10434-018-07133-6
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发表时间：
2019-06-01
影响因子：
3.7
通讯作者：
Sofocleous, Constantinos T.
中科院分区：
文献类型：
--
作者：
Sotirchos, Vlasios S.;Fujisawa, Sho;Sofocleous, Constantinos T.
背景本研究旨在评估结直肠癌肝转移(CLM)消融后即刻快速荧光组织检查与标准病理和免疫组织化学(IHC)评估的相关性。方法：这项由美国国立卫生研究院支持的前瞻性研究纳入了2011年1月至2014年12月期间连续34例患者，其中53例消融了肝转移。消融结束后立即进行消融区芯针取样。组织样本用荧光染色(MitoTracker Red)和核染色(Hoechst)进行评估。消融后30min内行共聚焦显微镜成像。同样的样本随后被固定，并用苏木素和曙红(H&E)染色。对鉴定出的肿瘤细胞进行免疫组织化学染色，检测细胞增殖(Ki67)和存活率(OxPhos)。这位研究病理学家对H&E和IHC的评估视而不见，分别评估了荧光图像以检测活的肿瘤细胞。计算荧光与H&E和IHC评估的敏感性、特异性和总体一致性。结果共收集并处理了63份组织样本。即时荧光与随后的H&E和IHC评估的总体符合率为94%(59/63)。荧光检测肿瘤细胞的敏感度和特异度分别为100%(18/18)和91%(41/45)。结论即时荧光检测与消融区的标准H&E和IHC评估具有较高的符合率。鉴于有文献记载消融区组织特征对CLM消融后预后的预测价值，荧光评估提供了一个潜在的完全肿瘤消融的术中生物标记物。
BackgroundThis study aimed to evaluate whether rapid fluorescent tissue examination immediately after colorectal cancer liver metastasis (CLM) ablation correlates with standard pathologic and immunohistochemical (IHC) assessments.MethodsThis prospective, National Institutes of Health-supported study enrolled 34 consecutive patients with 53 CLMs ablated between January 2011 and December 2014. Immediately after ablation, core needle sampling of the ablation zone was performed. Tissue samples were evaluated with fluorescent viability (MitoTracker Red) and nuclear (Hoechst) stains. Confocal microscope imaging was performed within 30min after ablation. The same samples were subsequently fixed and stained with hematoxylin and eosin (H&E). Identified tumor cells underwent IHC staining for proliferation (Ki67) and viability (OxPhos). The study pathologist, blinded to the H&E and IHC assessment, evaluated the fluorescent images separately to detect viable tumor cells. Sensitivity, specificity, and overall concordance of the fluorescent versus H&E and IHC assessments were calculated.ResultsA total of 63 tissue samples were collected and processed. The overall concordance rate between the immediate fluorescent and the subsequent H&E and IHC assessments was 94% (59/63). The fluorescent assessment sensitivity and specificity for the identification of tumor cells were respectively 100% (18/18) and 91% (41/45).ConclusionsThe study showed a high concordance rate between the immediate fluorescent assessment and the standard H&E and IHC assessment of the ablation zone. Given the documented prognostic value of ablation zone tissue characteristics for outcomes after ablation of CLM, the fluorescent assessment offers a potential intra-procedural biomarker of complete tumor ablation.