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Diagnostic accuracy of confocal laser endomicroscopy for the ex vivo characterization of peritoneal nodules during laparoscopic surgery

Abstract

Background

Intraoperative characterization of peritoneal nodules can be challenging. Probe-based confocal laser endomicroscopy (pCLE) is an innovative technique enabling real-time microscopic analysis. This study aimed to assess the role of pCLE in the discrimination of benign versus malignant peritoneal nodules during laparoscopic staging.

Materials and methods

During this prospective trial, pCLE was performed ex vivo on fresh samples of peritoneal nodules in 30 consecutive patients, after topical application of indocyanine green. The final diagnosis was obtained histologically, as per standard of care. pCLE image criteria for normal versus inflammatory versus malignant nodules were established (phase I); these criteria were tested retrospectively on selected videos by two examiners (phase II). The primary endpoints were values of accuracy in diagnosing malignant nodules.

Results

pCLE criteria for malignant nodules defined in phase I were: strongly fluorescent irregular clusters of cancerous cells, nonfluorescent nuclei of cancerous cells, and substantially lower fluorescence of the extracellular matrix fluorescence compared with cancerous clusters. In phase II, the detection rate of these criteria was significantly higher in malignant compared with benign nodules. Overall sensitivity, specificity, positive and negative predictive values to detect malignant nodules were 75, 100, 100 and 89 %, respectively. Interobserver agreement was substantial (kappa 0.69).

Conclusion

These preliminary results suggest that pCLE is a valuable tool to discriminate between benign and malignant peritoneal nodules, with a high positive predictive value.

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Acknowledgments

We would like to thank Pauline La Fay, Siddharth Maskara from Mauna Kea Technologies, Bérengère Bardou from Endocontrol for additional logistical support during the trial and BPI France for financial support.

Author information

Correspondence to David Fuks.

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Disclosures

The study was funded by BPI France: #I0911038 W Prof. Brice Gayet is a consultant for Mauna Kea Technologies. Mr. Pierangelo, Dr. Fuks, Dr. Validire, Prof. Gayet have received funding from Mauna Kea Technologies to support congress registration and travel fees. Dr. Benali has no conflict of interest or financial ties to disclose.

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Pierangelo, A., Fuks, D., Benali, A. et al. Diagnostic accuracy of confocal laser endomicroscopy for the ex vivo characterization of peritoneal nodules during laparoscopic surgery. Surg Endosc 31, 1974–1981 (2017) doi:10.1007/s00464-016-5172-7

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Keywords

  • Confocal laser endomicroscopy
  • Fluorescence
  • Peritoneal carcinosis
  • Extracellular matrix