Diagnosis Of ESD Surgical Margin In Early Gastric Cancer With Multiphoton Microscopy

For the past few years,endoscopy has been widely used and developed in clinic,so the early metaphase diagnosis rate of gastric cancer has been increasing.In the context,the Endoscopic Submucosal Dissection(ESD)has become a main choice for the treatment of early gastric cancer.Because the status of the resection margins is related to tumor recurrence and survival rate,it is necessary to diagnose the residual cancer cells whether exists or not in the ESD surgical margins,which is quite important to improve the curative rate of early gastric cancer.At present,the clinical commonly used endoscopy imaging can not reach the cellular level.Multiphoton Microscopy(MPM)can be used for the nondestructive imaging of biological tissue on a cellular level,so it can meet the conditions to carry out real-time guidance for endoscopic therapy.This paper aims to explore the application potential of MPM in the diagnosis of ESD surgical margins of early gastric cancer.First of all,the circumferential and bottom resection margin of the ESD specimens was respectively scanned and imaged by MPM,and the quantitative information from collagen was extracted.In this way,we established multiphoton diagnostic criteria of ESD margin in early gastric cancer,showing the cytological and morphological differences to accurately identify negative or positive margin.Then,based on the multiphoton diagnostic criteria,a double-blind experiment was designed to evaluate the diagnosis results of MPM.Results showed that MPM images were comparable to H-E images.The sensitivity,specificity,accuracy,negative predictive value,positive predictive value of MPM in the diagnosis of ESD surgical margin was 97.62%,75.00%,94.00%,95.35%,85.71%.This work indicates that MPM can be used as an effective,instant and label-free new method to judge the resection margins and provide quantitative information.With the invent of multiphoton endoscopy,MPM is expected to be an important tool to guide the treatment of early gastric cancer and other digestive diseases.