Real-time Histological Evaluation of Gastric Cancer Tissue by Using a Confocal Laser Endomicroscopic System

• Published in: In vivo (Athens) 2024-03, Vol.38 (2), p.855-863
• Main Authors: Bae, Hyunsik, Cho, Haeyon, Jo, Yeonju, Heo, So Mi, Chu, Jinah, Choi, Sangjoon, Hwang, Kyungmin, Kim, Kyuyoung, Kim, Seokhwi
• Format: Article
• Language: English
• Subjects: Eosine Yellowish-(YS); Fluorescein; Humans; Lasers; Microscopy, Confocal - methods; Stomach Neoplasms - diagnosis; Stomach Neoplasms - pathology
• ISSN: 0258-851X; 1791-7549
• DOI: 10.21873/invivo.13511

The need for instant histological evaluation of fresh tissue, especially in cancer treatment, remains paramount. The conventional frozen section technique has inherent limitations, prompting the exploration of alternative methods. A recently developed confocal laser endomicroscopic system provides real-time imaging of the tissue without the need for glass slide preparation. Herein, we evaluated its applicability in the histologic evaluation of gastric cancer tissues. A confocal laser endomicroscopic system (CLES) with a Lissajous pattern laser scanning, was developed. Fourteen fresh gastric cancer tissues and the same number of normal gastric tissues were obtained from advanced gastric cancer patients. Fluorescein sodium was used for staining. Five pathologists interpreted 100 endomicroscopic images and decided their histologic location and the presence of cancer. Following the review of matched hematoxylin and eosin (H&E) slides, their performance was evaluated with another 100 images. CLES images mirrored gastric tissue histology. Pathologists were able to detect the histologic location of the images with 65.7% accuracy and differentiate cancer tissue from normal with 74.7% accuracy. The sensitivity and specificity of cancer detection were 71.9% and 76.1%. Following the review of matched H&E images, the accuracy of identifying the histologic location was increased to 92.8% (p