Diagnosis of visceral pleural invasion using confocal laser endomicroscopy during lung cancer surgery

• Material Type: 博士論文
• Title: Diagnosis of visceral pleural invasion using confocal laser endomicroscopy during lung cancer surgery
• Author/Editor: Sawada, Toru; Takizawa, Hiromitsu; Aoyama, Mariko; Kawakita, Naoya; Miyamoto, Naoki; Sakamoto, Shinichi; Takashima, Mika; Matsumoto, Daisuke; Toba, Hiroaki; Kawakami, Yukikiyo; Yoshida, Mitsuteru; Kondo, Kazuya; Tangoku, Akira
• Author Heading: Sawada, Toru; Takizawa, Hiromitsu; Aoyama, Mariko; Kawakita, Naoya; Miyamoto, Naoki; Sakamoto, Shinichi; Takashima, Mika; Matsumoto, Daisuke; Toba, Hiroaki; Kawakami, Yukikiyo; Yoshida, Mitsuteru; Kondo, Kazuya; Tangoku, Akira
• Publication, Distribution, etc.: AME Publishing Company
• Publication Date: 2021-08
• Publication Date (W3CDTF): 2021-08
• Alternative Title: 共焦点レーザー内視鏡を用いた肺癌手術における臓側胸膜浸潤診断; CLE for visceral pleural invasion
• Periodical title: Journal of Thoracic Disease
• No. or year of volume/issue: 13 8
• Volume: 13
• Issue: 8
• Pages: 4742-4752
• ISSN (Periodical Title): ISSN : 2072-1439; ISSN : 2077-6624
• Degree grantor/type: 徳島大学
• Date Granted: 2021-09-30
• Dissertation Number: 甲第3555号
• Degree Type: 博士（医学）
• Text Language Code: eng
• Subject Heading: 肺癌; 胸膜浸潤; 共焦点; 自家蛍光; 診断; Lung cancer; visceral pleural invasion (VPI); confocal laser endomicroscopy (CLE)
• Target Audience: 一般
• Note (General): Background: Visceral pleural invasion (VPI) in lung cancer is a significant prognostic factor; however, it is difficult to diagnose preoperatively or intraoperatively. In this study, we examined the possibility of intraoperative diagnosis of VPI using confocal laser endomicroscopy (CLE). Methods: Among patients with primary lung cancer who underwent surgery between April 2018 and August 2019, those in whom the tumor was in contact with the pleura on chest computed tomography and whose pleural changes were intraoperatively confirmed were enrolled in this study. In the 35 patients who underwent lung resection (6 cases with visceral pleural infiltration), the area where pleural change was noted was observed and a short video was recorded using CLE. Based on the video images, three evaluators determined the defect ratio (0%, 25%, 50%, 75%, and 100%) of the autofluorescence-positive structure. The area under the receiver operating characteristic curve was used to evaluate the diagnostic performance for VPI. In 15 cases (3 cases with VPI), a validation study was performed for intraoperative VPI according to the cutoff value of the defect ratio of the autofluorescence-positive structure. Results: The areas under the receiver operating characteristic curve for the defect ratio of the autofluorescence-positive structure were 0.86–0.91 for the three readers. Using defect ratio of autofluorescence-positive structure cutoff of ≥50% as predictor of VPI, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 83.3–100.0%, 57.7–73.1%, 35.3–41.7%, 95.0–100.0%, and 75.0–78.1%, respectively, for the three readers. In the validation study, the sensitivity was 100%, the specificity was 83.3%, and the diagnostic accuracy rate was 86.7%. Conclusions: The diagnosis of VPI through CLE is simple, non-invasive, and has high diagnostic accuracy rates. This method may be applicable for determining surgical procedures.
• Format (IMT): application/pdf
• Access Restrictions: インターネット公開
• Rights (production): This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/
• Related Material (DOI): 10.21037/jtd-21-137
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 徳島大学 : 徳島大学機関リポジトリ

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http://repo.lib.tokushima-u.ac.jp/files/public/11/116384/2021100714230987179/k3555_abstract_review.pdf fulltext

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