徳島大学 教育・研究者情報データベース(EDB)

1. 澤田 徹

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2. 滝沢 宏光([徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.胸部・内分泌・腫瘍外科学]/[徳島大学.病院.診療科.外科.呼吸器外科])

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3. 青山 万理子([徳島大学.大学院医歯薬学研究部.医学域.先端医学教育研究プロジェクト]/[徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.胸部・内分泌・腫瘍外科学])

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4. 河北 直也([徳島大学.大学院医歯薬学研究部.医学域.先端医学教育研究プロジェクト]/[徳島大学.大学院医歯薬学研究部.医学域.医科学部門.外科系.胸部・内分泌・腫瘍外科学]/[徳島大学.病院.診療科.外科.呼吸器外科])

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5. (英) Miyamoto Naoki / (日) 宮本 直輝 / (読) みやもと なおき

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6. (英) Sakamoto Shinichi / (日) 坂本 晋一 / (読) さかもと しんいち

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7. 髙嶋 美佳

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8. 松本 大資

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9. 鳥羽 博明([徳島大学.大学院医歯薬学研究部.保健学域.保健科学部門.看護学系.臨床腫瘍医療学])

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10. 川上 行奎

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11. 吉田 光輝

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12. 近藤 和也

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13. 丹黒 章

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

(英) 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). 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. 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%. 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.

1. (英) Article.ELocationID: 10.21037/jtd-21-137

2. (英) Article.PublicationTypeList.PublicationType: Journal Article

3. (英) KeywordList.Keyword: Lung cancer

4. (英) KeywordList.Keyword: confocal laser endomicroscopy (CLE)

5. (英) KeywordList.Keyword: visceral pleural invasion (VPI)

6. (英) CoiStatement: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-137). KK serves as an unpaid editorial board member of Journal of Thoracic Disease. HT serves as an unpaid editorial board member of Journal of Thoracic Disease from Feb 2021 to Jan 2023. The other authors have no conflicts of interest to declare.