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ID 116384
タイトル別表記
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
著者
澤田, 徹 徳島大学大学院医科学教育部(医学専攻)
Miyamoto, Naoki Tokushima University
Sakamoto, Shinichi Tokushima University
キーワード
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)
資料タイプ
学位論文
抄録
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.
掲載誌名
Journal of Thoracic Disease
ISSN
20721439
20776624
出版者
AME Publishing Company
13
8
開始ページ
4742
終了ページ
4752
発行日
2021-08
備考
内容要旨・審査要旨・論文本文の公開
本論文は,著者Toru Sawadaの学位論文として提出され, 学位審査・授与の対象となっている。
権利情報
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/
出版社版DOI
出版社版URL
フルテキストファイル
言語
eng
著者版フラグ
博士論文全文を含む
文科省報告番号
甲第3555号
学位記番号
甲医第1508号
学位授与年月日
2021-09-30
学位名
博士(医学)
学位授与機関
徳島大学
部局
病院
医学系