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A novel approach of optical biopsy using probe-based confocal laser endomicroscopy for peritoneal metastasis

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Abstract

Background

In digestive cancers, it is mandatory to diagnose peritoneal metastasis prior to selecting therapy. Therefore, exploratory laparoscopy has gained wider clinical acceptance. In laparoscopy, the peritoneal metastasis is pathologically confirmed by excisional biopsy; however, there remain technical difficulties in performing precise diagnosis and adequate biopsy on small peritoneal lesions without damaging organs. We have focused on “optical biopsy” using probe-based confocal laser endomicroscopy (pCLE). The aims of this study were (1) to optimize current CLE system for real-time observation of peritoneal metastases and (2) to assess its potential usefulness as diagnostic modality in preclinical settings.

Methods

To optimize condition and evaluate feasibility, we prepared peritoneal metastasis mice model with gastric cancer cell line (MKN-45). On Day 10 after seeding, the mice were laparotomized and performed pCLE observations with CellvizioLAB (LSU-F 400/488 nm, Mauna Kea Technologies, Paris, France). We evaluated two different CLE probes, three different dyes, and optimal interval time. The detected sites were excised and pathologically evaluated on its morphology. Next, the feasibility and safety were validated in porcine model for clinical usage. After injection of fluorescein, pCLE was applied for the observation of intra-abdominal organs.

Result

A miniature probe-type pCLE system with 60 μm focal depth (UltraMini O) and 1 % fluorescein dye was chosen for good visualization in mice model. The irregular microarchitecture images suspected to malignancy were obtained from the metastases. In the porcine model, observation of abdominal organs was feasible without any organ injury in the laparoscopic procedures. The dosage of 1 % fluorescein (3 ml/body) was appropriate in observing intra-abdominal organs, and each intra-abdominal organ was clearly observed with the same imaging quality we obtained in mice model.

Conclusion

The pCLE was feasible and safe and potentially useful for the diagnosis of the peritoneal metastasis in in vivo animal models.

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Acknowledgments

We would like to thank M. Fujimoto and S. Serada for their instructions of basic experimental methods. This work was partially supported by Japan NOTES Research Grant.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan

    Hisashi Hara, Tsuyoshi Takahashi, Rie Nakatsuka, Shigeyoshi Higashi, Yasuhiro Miyazaki, Tomoki Makino, Yukinori Kurokawa, Makoto Yamasaki, Shuji Takiguchi, Masaki Mori, Yuichiro Doki & Kiyokazu Nakajima

  2. Laboratory for Immune Signal, National Institute of Biomedical Innovation, Health and Nutrition, Ibaraki, Japan

    Hisashi Hara, Tsuyoshi Takahashi, Rie Nakatsuka & Tetsuji Naka

  3. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

    Kazuki Sumiyama

  4. Division of Next Generation Endoscopic Intervention, Osaka University, Suite 0912, Center of Medical Innovation and Translational Research, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Shigeyoshi Higashi & Kiyokazu Nakajima

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  1. Hisashi Hara
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Correspondence to Kiyokazu Nakajima.

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Drs. Hara H., Natatsuka R., Higashi S., Miyazaki Y., Makino T., Kurokawa Y., Yamasaki Y., Takiguchi S., Mori M., Dok Y., and Nakajima K. have no conflicts of interest or financial ties to disclose. Dr. Takahashi T. has received honoraria from SBI Pharmaceuticals Co, Ltd.

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Hara, H., Takahashi, T., Nakatsuka, R. et al. A novel approach of optical biopsy using probe-based confocal laser endomicroscopy for peritoneal metastasis. Surg Endosc 30, 3437–3446 (2016). https://doi.org/10.1007/s00464-015-4626-7

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