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Real-time optical diagnosis for surgical margin in low rectal cancer using multiphoton microscopy

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Abstract

Background

Multiphoton microscopy (MPM), based on advances in the field of nonlinear optics and femtosecond lasers, has been shown to provide detailed real-time information on tissue architecture and cell morphology in live tissue. The purpose of this study was to evaluate the feasibility of using MPM to make real-time optical diagnoses for surgical margins in low rectal cancers.

Methods

Thirty fresh, unfixed, and unstained full-thickness surgical margins of low rectal cancers underwent MPM examination and then went through intraoperative frozen procedures and routine pathological procedures. MPM images were compared with the gold standard hematoxylin–eosin (H–E) stained images.

Results

MPM images were acquired by two channels: broadband autofluorescence from cells and second harmonic generation (SHG) from tissue collagen. Peak multiphoton signal intensity was detected in mucosa excited at 800 nm. There were significant differences between negative surgical margins and positive surgical margins under MPM examination. In negative surgical margins, MPM revealed regular tissue architecture and cell morphology, including a typical foveolar pattern with central, round crypt openings, and glands lined by epithelial and goblet cells. SHG signals could be detected around the glands. In positive surgical margins, MPM demonstrated irregular tubular structures, reduced stroma, and cellular and nuclear pleomorphisms. Cancer cells were characterized by an irregular size and shape, enlarged nuclei, and an increased nuclear–cytoplasmic ratio. SHG signals were significantly decreased in positive surgical margins compared with negative surgical margins. MPM images were comparable to H–E stained images.

Conclusions

We demonstrated the feasibility of using MPM to make real-time optical diagnoses for surgical margins in low rectal cancer. With the miniaturization and integration of colonoscopy or probes, MPM has the potential to provide real-time noninvasive optical diagnosis for surgical margins in low rectal cancer in the near future.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (81272574, 61275006, and 81271620), the Program for Changjiang Scholars and Innovative Research Team in University (Grant No. IRT1115), the Natural Science Foundation of Fujian Province (2010J01136, 2011J01341, and 2012J01326), the Medical Innovation Program of Fujian Province (2012-CX-7 and 2012-CXB-7), and the Program from Education Bureau of Fujian Province (JA12057).

Disclosures

Jun Yan, Shuangmu Zhuo, Gang Chen, Jeffrey W. Milsom, Hui Zhan, Jianping Lu, Weifeng Zhu, Shusen Xie, Jianxin Chen, and Mingang Ying have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People’s Republic of China

    Jun Yan

  2. Fujian Provincial Key Laboratory for Photonics Technology, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, Institute of Laser and Optoelectronics Technology, Fujian Normal University, Fuzhou, 350007, People’s Republic of China

    Shuangmu Zhuo, Shusen Xie & Jianxin Chen

  3. Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, 350014, People’s Republic of China

    Jun Yan, Gang Chen, Hui Zhang, Jianping Lu, Weifeng Zhu & Mingang Ying

  4. Fujian University of Traditional Chinese Medicine, Fuzhou, 350108, People’s Republic of China

    Jun Yan & Gang Chen

  5. Section of Colon and Rectal Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, 10021, USA

    Jeffrey W. Milsom

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  1. Jun Yan
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  2. Shuangmu Zhuo
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  3. Gang Chen
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Corresponding authors

Correspondence to Jun Yan or Shuangmu Zhuo.

Additional information

Jun Yan, Shuangmu Zhuo, and Gang Chen have contributed equally to this study.

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Yan, J., Zhuo, S., Chen, G. et al. Real-time optical diagnosis for surgical margin in low rectal cancer using multiphoton microscopy. Surg Endosc 28, 36–41 (2014). https://doi.org/10.1007/s00464-013-3153-7

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  • DOI: https://doi.org/10.1007/s00464-013-3153-7

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