The Optical Biopsy: A Novel Technique for Rapid Intraoperative Diagnosis of Primary Pulmonary Adenocarcinomas
The Optical Biopsy: A Novel Technique for Rapid Intraoperative Diagnosis of Primary Pulmonary Adenocarcinomas
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DOI：
10.1097/sla.0000000000001452
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发表时间：
2015-10-01
影响因子：
9
通讯作者：
Singhal, Sunil
中科院分区：
文献类型：
--
作者：
Kennedy, Gregory T.;Okusanya, Olugbenga T.;Singhal, Sunil
背景：随着胸部计算机断层扫描的使用越来越多，不确定的肺部结节经常被偶然发现并提出诊断挑战。组织活检、随后的组织学检查和免疫组织化学是获得诊断的金标准，最常见的恶性发现是原发性肺腺癌。我们的目的是确定术中光学活检（分子成像）是否可以提供另一种方法来确定肺结节是否是原发性肺腺癌。方法：在手术前，对 30 名不确定肺结节患者静脉注射针对原发性肺腺癌的叶酸受体靶向荧光造影剂。在手术过程中，切除结节，并在手术室评估荧光（光学活检）的存在，以确定结节是否是原发性肺腺癌。然后对永久切片进行标准护理冰冻切片和免疫组织化学染色作为验证光学活检结果的金标准。结果：光学活检鉴定出 19 例原发性肺腺癌中的 19 例 (100%)。没有出现假阳性或假阴性诊断。光学活检需要 2.4 分钟，而冰冻切片则需要 26.5 分钟（P
Background:With increasing use of chest computed tomography scans, indeterminate pulmonary nodules are frequently detected as an incidental finding and present a diagnostic challenge. Tissue biopsy followed by histological review and immunohistochemistry is the gold standard to obtain a diagnosis and the most common malignant finding is a primary lung adenocarcinoma. Our objective was to determine whether an intraoperative optical biopsy (molecular imaging) may provide an alternative approach for determining if a pulmonary nodule is a primary lung adenocarcinoma.Methods:Before surgery, 30 patients with an indeterminate pulmonary nodule were intravenously administered a folate receptor-targeted fluorescent contrast agent specific for primary lung adenocarcinomas. During surgery, the nodule was removed and the presence of fluorescence (optical biopsy) was assessed in the operating room to determine if the nodule was a primary pulmonary adenocarcinoma. Standard-of-care frozen section and immunohistochemical staining on permanent sections were then performed as the gold standard to validate the results of the optical biopsy.Results:Optical biopsies identified 19 of 19 (100%) primary pulmonary adenocarcinomas. There were no false positive or false negative diagnoses. An optical biopsy required 2.4 minutes compared to 26.5 minutes for frozen section (P