Clinical approved fluorescent dyes coupled to endomicroscopy for in vivo diagnostic of peritoneal carcinomatosis
2015
Peritoneal carcinomatosis is metastatic stage aggravating digestive, gynecological or bladder cancer dissemination and
the preoperative evaluation of lesions remains difficult. There is therefore a need for minimal invasive innovative
techniques to establish a precise preoperative assessment of cancer peritoneal cavity. Probe-based confocal laser
endomicroscopy (pCLE) provides dynamic images of the microarchitecture of tissues during an endoscopy. The
PERSEE project proposes new developments in robotics and pCLE for the exploration of the peritoneal cavity during
laparoscopy.
Two fluorescent dyes, Patent blue V and Indocyanine green have been evaluated on human ex vivo samples to improve
the contrast of pCLE images. For a future implementation in clinical study, two topically staining protocols operable in
vivo have been validated on 70 specimens from 25 patients with a peritoneal carcinomatosis. The specimens were then
imaged by pCLE with an optical probe designed for the application. A histo-morphological correlative study was
performed on 350 pCLE images and 70 standard histological preparations. All images were interpreted in a random way
by two pathologists.
Differential histological diagnostics such as normal peritoneum or pseudomyxoma could be recognized on fluorescence
images. The statistical analysis of the correlative study is underway. These dyes already approved for human use are
interesting for pCLE imaging because some micromorphological criteria look like to conventional histology and are
readable by pathologist. Thus pCLE images using both dyes do not require a specific semiology unlike to what is
described in the literature, for pCLE associated with fluorescein for the in vivo imaging of pancreatic cysts.
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