Confocal chromolaser endomicroscopy: a supplemental diagnostic tool prior to transanal endoscopic microsurgery of rectal tumors
Purpose Due to diagnostic advancements, preoperative staging of rectal tumors was significantly improved. However, difficulties in obtaining accurate results can sometimes be observed in the staging of adenomas and early rectal carcinomas (pT1/2). The aim of this study was to test if confocal chromo...
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| Veröffentlicht in: | International journal of colorectal disease 2010, Vol.25 (1), p.71-77 |
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| description | Purpose Due to diagnostic advancements, preoperative staging of rectal tumors was significantly improved. However, difficulties in obtaining accurate results can sometimes be observed in the staging of adenomas and early rectal carcinomas (pT1/2). The aim of this study was to test if confocal chromolaser endomicroscopy (cCLEM) can help minimize this diagnostic gap. Methods cCLEM generates optical transversal sections at ×1,000 magnification and allows for evaluation of the mucosal microarchitecture and differentiation of normal mucosa from adenomas and carcinomas. Cases with conflicting preoperative findings (adenoma vs. ≥uT2 categories), undetectable tumors after inadequate (R1/RX) snare polypectomy of carcinomas, and extremely flat adenoma areas were studied. Results By cCLEM, in ≥uT2 carcinomas with an adenoma histology, malignoma-suspicious areas were identified and selected biopsies were done. In addition, re-epithelialized polypectomy areas of carcinomas were visualized and targeted reoperations could be carried out. Furthermore, the dignity and extension of extremely flat adenomas were determined and marked by clips for additional therapy. Conclusions In cases with rectal tumors, conflicting or unclear findings, and flat extending adenomas, the utilization of cCLEM should be considered. Especially in cases with early rectal carcinomas, unnecessary second operations and also recurrences can be minimized or even avoided by selective usage of cCLEM. |
| doi_str_mv | 10.1007/s00384-009-0813-0 |
| format | Article |
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However, difficulties in obtaining accurate results can sometimes be observed in the staging of adenomas and early rectal carcinomas (pT1/2). The aim of this study was to test if confocal chromolaser endomicroscopy (cCLEM) can help minimize this diagnostic gap. Methods cCLEM generates optical transversal sections at ×1,000 magnification and allows for evaluation of the mucosal microarchitecture and differentiation of normal mucosa from adenomas and carcinomas. Cases with conflicting preoperative findings (adenoma vs. ≥uT2 categories), undetectable tumors after inadequate (R1/RX) snare polypectomy of carcinomas, and extremely flat adenoma areas were studied. Results By cCLEM, in ≥uT2 carcinomas with an adenoma histology, malignoma-suspicious areas were identified and selected biopsies were done. In addition, re-epithelialized polypectomy areas of carcinomas were visualized and targeted reoperations could be carried out. Furthermore, the dignity and extension of extremely flat adenomas were determined and marked by clips for additional therapy. Conclusions In cases with rectal tumors, conflicting or unclear findings, and flat extending adenomas, the utilization of cCLEM should be considered. Especially in cases with early rectal carcinomas, unnecessary second operations and also recurrences can be minimized or even avoided by selective usage of cCLEM.</description><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-009-0813-0</identifier><identifier>PMID: 19888590</identifier><identifier>CODEN: IJCDE6</identifier><language>eng</language><publisher>Berlin/Heidelberg: Berlin/Heidelberg : Springer-Verlag</publisher><subject>Adenoma - diagnostic imaging ; Adenoma - pathology ; Adenoma - surgery ; Anal Canal - diagnostic imaging ; Anal Canal - pathology ; Anal Canal - surgery ; Biological and medical sciences ; Colorectal cancer ; Diagnosis ; Diagnostic Techniques and Procedures ; Diathermy ; Endoscopy ; Endoscopy - methods ; Epithelium - pathology ; Gastroenterology ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastrointestinal diseases ; Hepatology ; Humans ; Internal Medicine ; Medical sciences ; Medicine ; Medicine & Public Health ; Methylene blue ; Microscopy, Confocal - methods ; Microsurgery - methods ; Mucous Membrane - pathology ; Mucous Membrane - surgery ; Original Article ; Proctology ; Rectal Neoplasms - diagnosis ; Rectal Neoplasms - diagnostic imaging ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Surgery ; Tumors ; Ultrasonography</subject><ispartof>International journal of colorectal disease, 2010, Vol.25 (1), p.71-77</ispartof><rights>Springer-Verlag 2009</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2010 Springer</rights><rights>Springer-Verlag 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c491t-223ba6bed6cb27019a419d916bbf4fc647b8dbb27083c6d5fbf0fe0d66f70e5c3</citedby><cites>FETCH-LOGICAL-c491t-223ba6bed6cb27019a419d916bbf4fc647b8dbb27083c6d5fbf0fe0d66f70e5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-009-0813-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-009-0813-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,4009,27902,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22337812$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19888590$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Borschitz, Thomas</creatorcontrib><creatorcontrib>Kiesslich, Ralf</creatorcontrib><title>Confocal chromolaser endomicroscopy: a supplemental diagnostic tool prior to transanal endoscopic microsurgery of rectal tumors</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Purpose Due to diagnostic advancements, preoperative staging of rectal tumors was significantly improved. However, difficulties in obtaining accurate results can sometimes be observed in the staging of adenomas and early rectal carcinomas (pT1/2). The aim of this study was to test if confocal chromolaser endomicroscopy (cCLEM) can help minimize this diagnostic gap. Methods cCLEM generates optical transversal sections at ×1,000 magnification and allows for evaluation of the mucosal microarchitecture and differentiation of normal mucosa from adenomas and carcinomas. Cases with conflicting preoperative findings (adenoma vs. ≥uT2 categories), undetectable tumors after inadequate (R1/RX) snare polypectomy of carcinomas, and extremely flat adenoma areas were studied. Results By cCLEM, in ≥uT2 carcinomas with an adenoma histology, malignoma-suspicious areas were identified and selected biopsies were done. In addition, re-epithelialized polypectomy areas of carcinomas were visualized and targeted reoperations could be carried out. Furthermore, the dignity and extension of extremely flat adenomas were determined and marked by clips for additional therapy. Conclusions In cases with rectal tumors, conflicting or unclear findings, and flat extending adenomas, the utilization of cCLEM should be considered. Especially in cases with early rectal carcinomas, unnecessary second operations and also recurrences can be minimized or even avoided by selective usage of cCLEM.</description><subject>Adenoma - diagnostic imaging</subject><subject>Adenoma - pathology</subject><subject>Adenoma - surgery</subject><subject>Anal Canal - diagnostic imaging</subject><subject>Anal Canal - pathology</subject><subject>Anal Canal - surgery</subject><subject>Biological and medical sciences</subject><subject>Colorectal cancer</subject><subject>Diagnosis</subject><subject>Diagnostic Techniques and Procedures</subject><subject>Diathermy</subject><subject>Endoscopy</subject><subject>Endoscopy - methods</subject><subject>Epithelium - pathology</subject><subject>Gastroenterology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastrointestinal diseases</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methylene blue</subject><subject>Microscopy, Confocal - methods</subject><subject>Microsurgery - methods</subject><subject>Mucous Membrane - pathology</subject><subject>Mucous Membrane - surgery</subject><subject>Original Article</subject><subject>Proctology</subject><subject>Rectal Neoplasms - diagnosis</subject><subject>Rectal Neoplasms - diagnostic imaging</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Surgery</subject><subject>Tumors</subject><subject>Ultrasonography</subject><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kk-PlTAUxRujcZ6jH8CNEo1xxXj7h9LObvIyoyaTuNBZN6W0TyZAsYXFW_nVvYQXJxpjWADt7xx6z4GQlxQuKED9IQNwJUoAXYKivIRHZEcFZyVlkj0mO6C1Lqmu1Bl5lvM94LusxVNyRrVSqtKwIz_3cQzR2b5w31McYm-zT4Uf2zh0LsXs4nS8LGyRl2nq_eDHGdG2s4cx5rlzxRxjX0ypiwkfiznZMdsRkdVhFSOyGS3p4NOxiKFI3q0m8zLElJ-TJ8H22b843c_J3c31t_2n8vbLx8_7q9vSCU3nkjHeWNn4VrqG1UC1FVS3msqmCSI4KepGtc26pbiTbRWaAMFDK2WowVeOn5P3m--U4o_F59kMXXa-7-3o45JNzTFJEEwj-eYv8j4uCWfKhlFZUaU4RejtBh1s702HEeLobrU0VzUVQtUMJFIX_6Dwaj2GEkcfOlz_Q0A3wZpYTj4YjHaw6WgomLVys1VusHKzVm4ANa9O512awbcPilPHCLw7ATZj0QE7cl3-zWG0vFaUIcc2LuPWiG09DP6_r7_eRMFGYw8Jje--MqAc_zVQUnP-C9uNznQ</recordid><startdate>2010</startdate><enddate>2010</enddate><creator>Borschitz, Thomas</creator><creator>Kiesslich, Ralf</creator><general>Berlin/Heidelberg : Springer-Verlag</general><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>2010</creationdate><title>Confocal chromolaser endomicroscopy: a supplemental diagnostic tool prior to transanal endoscopic microsurgery of rectal tumors</title><author>Borschitz, Thomas ; Kiesslich, Ralf</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c491t-223ba6bed6cb27019a419d916bbf4fc647b8dbb27083c6d5fbf0fe0d66f70e5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adenoma - diagnostic imaging</topic><topic>Adenoma - pathology</topic><topic>Adenoma - surgery</topic><topic>Anal Canal - diagnostic imaging</topic><topic>Anal Canal - pathology</topic><topic>Anal Canal - surgery</topic><topic>Biological and medical sciences</topic><topic>Colorectal cancer</topic><topic>Diagnosis</topic><topic>Diagnostic Techniques and Procedures</topic><topic>Diathermy</topic><topic>Endoscopy</topic><topic>Endoscopy - methods</topic><topic>Epithelium - pathology</topic><topic>Gastroenterology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastrointestinal diseases</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methylene blue</topic><topic>Microscopy, Confocal - methods</topic><topic>Microsurgery - methods</topic><topic>Mucous Membrane - pathology</topic><topic>Mucous Membrane - surgery</topic><topic>Original Article</topic><topic>Proctology</topic><topic>Rectal Neoplasms - diagnosis</topic><topic>Rectal Neoplasms - diagnostic imaging</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Surgery</topic><topic>Tumors</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Borschitz, Thomas</creatorcontrib><creatorcontrib>Kiesslich, Ralf</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Borschitz, Thomas</au><au>Kiesslich, Ralf</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Confocal chromolaser endomicroscopy: a supplemental diagnostic tool prior to transanal endoscopic microsurgery of rectal tumors</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2010</date><risdate>2010</risdate><volume>25</volume><issue>1</issue><spage>71</spage><epage>77</epage><pages>71-77</pages><issn>0179-1958</issn><eissn>1432-1262</eissn><coden>IJCDE6</coden><abstract>Purpose Due to diagnostic advancements, preoperative staging of rectal tumors was significantly improved. However, difficulties in obtaining accurate results can sometimes be observed in the staging of adenomas and early rectal carcinomas (pT1/2). The aim of this study was to test if confocal chromolaser endomicroscopy (cCLEM) can help minimize this diagnostic gap. Methods cCLEM generates optical transversal sections at ×1,000 magnification and allows for evaluation of the mucosal microarchitecture and differentiation of normal mucosa from adenomas and carcinomas. Cases with conflicting preoperative findings (adenoma vs. ≥uT2 categories), undetectable tumors after inadequate (R1/RX) snare polypectomy of carcinomas, and extremely flat adenoma areas were studied. Results By cCLEM, in ≥uT2 carcinomas with an adenoma histology, malignoma-suspicious areas were identified and selected biopsies were done. In addition, re-epithelialized polypectomy areas of carcinomas were visualized and targeted reoperations could be carried out. Furthermore, the dignity and extension of extremely flat adenomas were determined and marked by clips for additional therapy. Conclusions In cases with rectal tumors, conflicting or unclear findings, and flat extending adenomas, the utilization of cCLEM should be considered. Especially in cases with early rectal carcinomas, unnecessary second operations and also recurrences can be minimized or even avoided by selective usage of cCLEM.</abstract><cop>Berlin/Heidelberg</cop><pub>Berlin/Heidelberg : Springer-Verlag</pub><pmid>19888590</pmid><doi>10.1007/s00384-009-0813-0</doi><tpages>7</tpages></addata></record> |
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| subjects | Adenoma - diagnostic imaging Adenoma - pathology Adenoma - surgery Anal Canal - diagnostic imaging Anal Canal - pathology Anal Canal - surgery Biological and medical sciences Colorectal cancer Diagnosis Diagnostic Techniques and Procedures Diathermy Endoscopy Endoscopy - methods Epithelium - pathology Gastroenterology Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal diseases Hepatology Humans Internal Medicine Medical sciences Medicine Medicine & Public Health Methylene blue Microscopy, Confocal - methods Microsurgery - methods Mucous Membrane - pathology Mucous Membrane - surgery Original Article Proctology Rectal Neoplasms - diagnosis Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - pathology Rectal Neoplasms - surgery Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Surgery Tumors Ultrasonography |
| title | Confocal chromolaser endomicroscopy: a supplemental diagnostic tool prior to transanal endoscopic microsurgery of rectal tumors |
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