Fiber-Optic Confocal Laser Endomicroscopy of Small Renal Masses: Toward Real-Time Optical Diagnostic Biopsy
Fiber-Optic Confocal Laser Endomicroscopy of Small Renal Masses: Toward Real-Time Optical Diagnostic Biopsy
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DOI：
10.1016/j.juro.2015.07.115
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发表时间：
2016-02-01
影响因子：
6.6
通讯作者：
Carter, Christopher M.
中科院分区：
文献类型：
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作者：
Su, Li-Ming;Kuo, Jennifer;Carter, Christopher M.
目的：肾小肿块的偶然检出呈上升趋势。然而，并不是所有的肿瘤都需要积极的治疗，因为高达20%的肿瘤是良性的，而大多数恶性肿瘤都有惰性的特征。需要改进术前诊断，以区分需要积极治疗的肿瘤和更适合监测的肿瘤。我们评估并比较了共聚焦激光内镜与标准组织病理学在离体人肾肿瘤诊断的原理证明光学活检。材料与方法：本研究纳入了计划行部分或根治性肾切除术的孤立性肾小肿块患者。两个肾脏通过术中静脉注射荧光素，18个肿瘤在共聚焦成像前浸泡在稀释的荧光素中。标本切开后，使用2.6 mm共聚焦激光内镜探头从外表面和内表面对肿瘤和周围实质进行成像。将激光共聚焦内镜图像与相应区域的标准苏木精和伊红分析进行比较。结果：体外共聚焦激光内镜成像显示肾脏结构正常，与组织学表现吻合良好。肿瘤组织很容易与正常实质区分，表现出良性和恶性肿瘤亚型的独特特征。局部荧光素给予比静脉注射途径提供更一致的共聚焦激光内镜成像。此外，正面肿瘤影像学优于外部影像学。结论：我们报告了据我们所知的第一个使用共聚焦激光内镜评估体外肾小肿块的可行性研究，并提供了相应组织学的各种肾肿瘤的初步图像图谱。这些发现为实时诊断肾小肿块的光学活检迈出了初步和有希望的一步。
Purpose: The incidental detection of small renal masses is increasing. However, not all require aggressive treatments as up to 20% are benign and the majority of malignant tumors harbor indolent features. Improved preoperative diagnostics are needed to differentiate tumors requiring aggressive treatment from those more suitable for surveillance. We evaluated and compared confocal laser endomicroscopy with standard histopathology in ex vivo human kidney tumors as proof of principle towards diagnostic optical biopsy.Materials and Methods: Patients with a solitary small renal mass scheduled for partial or radical nephrectomy were enrolled in study. Two kidneys were infused with fluorescein via intraoperative intravenous injection and 18 tumors were bathed ex vivo in dilute fluorescein prior to confocal imaging. A 2.6 mm confocal laser endomicroscopy probe was used to image tumors and surrounding parenchyma from external and en face surfaces after specimen bisection. Confocal laser endomicroscopy images were compared to standard hematoxylin and eosin analysis of corresponding areas.Results: Ex vivo confocal laser endomicroscopy imaging revealed normal renal structures that correlated well with histology findings. Tumor tissue was readily distinguishable from normal parenchyma, demonstrating features unique to benign and malignant tumor subtypes. Topical fluorescein administration provided more consistent confocal laser endomicroscopy imaging than the intravenous route. Additionally, en face tumor imaging was superior to external imaging.Conclusions: We report what is to our knowledge the first feasibility study using confocal laser endomicroscopy to evaluate small renal masses ex vivo and provide a preliminary atlas of images from various renal neoplasms with corresponding histology. These findings serve as an initial and promising step toward real-time diagnostic optical biopsy of small renal masses.