Background: Ex vivo fluorescence laser scanning microscopes (FCMs) allow digital tissue imaging directly from fresh, unfixed specimens without the need for conventional histological slide preparation. To date, no data have been reported on the use of FCMs in the endoscopy suite for immediate evaluation of endoscopic ultrasound (EUS)/endobronchial ultrasound (EBUS) fine needle aspiration/biopsy (FNA-B) specimens of lung lesions and/or mediastinal lymph nodes.Objectives: The aim of this study was to evaluate the performance of the FCM Vivascope 2500 (Vivascope, Munich, Germany) in providing real-time adequacy assessment and diagnostic information on the digital images of fresh unprocessed EUS/EBUS FNA-B specimens and to compare it with the corresponding final histological sections of formalin-fixed and paraffin-embedded cell blocks.Methods and Results: Thirty-two patients (50% male; 71 ± 8 years old) were enrolled between May 2023 and June 2024. In 28/32 (87.5%) patients, samples were defined as adequate at Vivascope evaluation, and in 20/28 (71.4%) patients, samples were classified as malignant. At final cytohistological evaluation, 87.5% of specimens were defined as adequate and 20/28 (71.4%) were diagnosed as malignant. There was perfect agreement between the Vivascope assessment of adequacy and the final cytohistological assessment on the same specimen (k Cohen 1). From a diagnostic point of view, perfect agreement was found between the two techniques in the identification of malignant neoplasms (k Cohen 1).Conclusions: The use of FCM could provide rapid information on both the adequacy and malignancy of the sample obtained during EBUS tissue acquisition (EBUS-TA), with minimal or no preparation and without destroying or losing the tissue. This technique allows for obtaining representative material in EBUS/EUS for lung cancer staging and is expected to change the turnaround time from biopsy sampling to diagnostic characterization of the tumor, ultimately improving patient management both at diagnosis and at restaging in follow up.
背景：离体荧光激光扫描显微镜（FCM）可直接对新鲜未固定的标本进行数字化组织成像，无需传统的组织学切片制备。迄今为止，尚未有关于在支气管内超声（EBUS）/内镜超声（EUS）引导下对肺部病灶和/或纵隔淋巴结进行细针穿刺活检（FNA-B）时，在操作现场使用FCM对标本进行即时评估的数据报道。 目的：本研究旨在评估Vivascope 2500型FCM（德国慕尼黑Vivascope公司）在提供新鲜、未经处理的EUS/EBUS FNA-B标本数字化图像的实时充分性评估和诊断信息方面的性能，并将其与福尔马林固定、石蜡包埋细胞块的最终组织学切片结果进行比较。 方法与结果：2023年5月至2024年6月期间，共纳入32例患者（男性占50%；平均年龄71±8岁）。在Vivascope评估中，28/32例（87.5%）患者的标本被判定为充分，其中20/28例（71.4%）患者的标本被归类为恶性。在最终的细胞组织学评估中，87.5%的标本被判定为充分，20/28例（71.4%）被诊断为恶性。Vivascope对标本充分性的评估与最终细胞组织学评估结果完全一致（Cohen's kappa系数为1）。从诊断角度来看，两种技术在恶性肿瘤识别方面也完全一致（Cohen's kappa系数为1）。 结论：使用FCM可在EBUS组织取样（EBUS-TA）过程中，以极少或无需标本制备、且不破坏或损失组织的方式，快速提供关于标本充分性及恶性与否的信息。该技术能够在EBUS/EUS操作中获取用于肺癌分期的代表性材料，有望改变从活检取样到肿瘤诊断特征分析的处理时间，最终改善患者在初诊及随访再分期中的诊疗管理。
肿瘤(癌症)患者之家